Postoperative Management Of Patients Research Articles

Optimization of acute postoperative pain management in trauma and orthopedic patients

Background. The modern approach to multimodal postoperative analgesia involves the administration of two or more analgesic agents that exert a polymodal effect on the pathogenetic mechanisms of pain. Nefopam hydrochloride can prevent opioid-induced hyperalgesia, relieve pain without respiratory depression and without affecting platelet aggregation, the state of the gastrointestinal mucosa and intestinal motility, which differentiates it from traditional non-opioid analgesics. Objective: to assess the impact of nefopam hydrochloride as a component of multimodal analgesia on pain intensity and stress response markers in trauma and orthopedic patients during postoperative pain management. Materials and methods. A prospective randomized open-label controlled clinical study was conducted in 120 patients (47 men, 73 women) aged 19 to 94 years (mean (M ± σ) of 55.97 ± 19.78 years) who underwent lower limb surgeries under spinal anesthesia. Patients were divided into two groups: the controls (n = 60) received standard multimodal analgesia (ketorolac, acetaminophen), while people in the main group (n = 60) additionally received 20 mg of nefopam hydrochloride intramuscularly 4 times per day. Pain intensity was evaluated using the Numeric Rating Scale, narcotic analgesic consumption, and cortisol levels in blood serum were assessed as well. Data analysis was performed using SPSS 20 (SPSS Inc.), version 21.0.0 for Windows. Results. It was found that the use of nefopam hydrochloride as a component of multimodal postoperative analgesia in patients undergoing trauma and orthopedic surgeries significantly reduces score on the Numeric Rating Scale: by 23.6 % during the first 6 hours after surgery (p < 0.001), and by 1.5, 2.3, and 3.6 times at 12, 18, and 24 hours postoperatively, respectively (p < 0.001). It was also associated with lower mean serum cortisol concentrations — 5.20 ± 4.43 vs. 8.51 ± 3.48 µg/dL in the control group 6 hours after surgery, and 2.08 ± 1.63 vs. 4.11 ± 1.70 µg/dL in 12 hours (p < 0.001). Additio-nally, it reduced the average cumulative morphine dose by 1.5 times during the first 24 hours postoperatively (p < 0.001). The opioid-reducing effect of multimodal analgesia with nefopam hydrochloride reached 61.7 %. Conclusions. Nefopam hydrochloride is an effective component of multimodal postoperative analgesia in trauma and orthopedic patients, improving the quality of postoperative pain management and reducing stress response intensity.

DOP104 International differences in pre-operative characteristics and postoperative management in patients with Crohn’s disease following ileocolic resection: a report from the IMPACT consortium

Abstract Background Intestinal surgery is a key treatment for Crohn’s disease (CD). Large cohort data on perioperative management are vital to improve postoperative outcomes. This study aimed to assess and compare preoperative characteristics and postoperative management across three large prospective cohort studies of CD patients following ileocolic resection (ICR). Methods The IMPACT consortium (International Multidisciplinary Research Collaboration on Postoperative IBD) is an intercontinental initiative focused on postoperative inflammatory bowel disease research. Prospective data were used from three ongoing cohort studies with a comparable set-up and data collection, including CD patients who underwent ICR between December 2009 and September 2024, originating from the Netherlands (NL), North-America (Canada [CAN] and United States of America [USA]) and France (FR). Pre-operative characteristics, clinical risk profiles for post-operative recurrence (POR), use of postoperative prophylactic medication and performance of endoscopic evaluation were compared between the involved countries. Results 1,601 patients with CD following ICR were included (455 NL, 149 CAN, 307 USA, 690 FR)(48.3% male; median age at surgery 33.7 years [IQR 25.8-46.6])(Table 1). Active smoking rates were higher in Europe (NL: 26.2%; FR: 32.8%) compared with North America (CAN: 13.2%; USA: 8.2%). Prior small bowel resections were more common in North American (CAN: 29.5%; USA: 27.0%) compared with Europe (NL: 20.0%; FR: 17.0%). Preoperative biological exposure was lower in Canada (55.7%) and the USA (56.0%) compared with the Netherlands (69.2%) and France (75.5%). A higher proportion of Dutch patients had non-complicated CD (Montreal B1) at surgery (18.4%) compared to other countries (CAN: 1.4%; USA: 2.3%; FR: 4.5%). Overall, 72.7% were considered high-risk for POR, with the lowest rates in the Dutch cohort (62.2%) compared to the other countries (CAN: 73.8%; USA: 77.9%; FR: 77.1%). Postoperative prophylactic medication was initiated in 42.2% with higher rates in the USA (45.9%) and France (51.0%) compared with the Netherlands (28.5%) and Canada (34.9%). Details on postoperative prophylactic medication use are provided in Table 2. An endoscopic evaluation within one year postoperatively was performed in 89.0% of patients, with higher rates (>85%) in the Netherlands, Canada, and France, compared with the USA (66.9%). Conclusion This first study of the IMPACT consortium revealed notable differences in preoperative characteristics, risk profiles for postoperative recurrence, use of prophylactic medication, and postoperative endoscopic evaluation across Europe and North America. Further analyses will include the assessment of rates and factors associated with endoscopic recurrence.

Vedolizumab to prevent postoperative recurrence of Crohn's disease (REPREVIO): a multicentre, double-blind, randomised, placebo-controlled trial.

Approximately half of patients with Crohn's disease require ileocolonic resection. Of these, 50% will subsequently have endoscopic disease recurrence within 1 year. We aimed to evaluate the efficacy and safety of vedolizumab to prevent postoperative recurrence of Crohn's disease. REPREVIO was a double-blind, randomised, placebo-controlled trial conducted at 13 academic or teaching hospitals in France, Italy, the Netherlands, and Spain. Eligible participants were adult patients aged 18 years or older with Crohn's disease who underwent ileocolonic resection and had one or more risk factors for recurrence. Patients were randomly assigned within 4 weeks of surgery (1:1 ratio) to receive intravenous vedolizumab (300 mg) or placebo at weeks 0, 8, 16, and 24. Randomisation was performed centrally with a computer-generated validated variable block model and patients were stratified according to disease behaviour (fibrostenotic vs inflammatory or perforating). Ileocolonoscopy was performed at week 26 and videorecorded. Endoscopic recurrence was centrally assessed with the modified Rutgeerts score, a categorial score ranging from i0 to i4. The primary endpoint was the distribution of modified Rutgeerts scores between treatment groups at week 26, analysed by non-parametric methods. The first-ranked secondary endpoint was the proportion of patients with severe endoscopic recurrence of Crohn's disease at week 26 (modified Rutgeerts score ≥i2b). Primary and safety analyses included all patients who underwent randomisation and received at least one dose of study drug. The trial is registered with the EU Clinical Trial Register (EudraCT; 2015-000555-24). Between May 16, 2017, and April 8, 2022, 84 patients were randomly assigned to treatment, of whom four did not receive study treatment, leaving 43 patients in the vedolizumab group and 37 in the placebo group. At week 26, the probability of a lower modified Rutgeerts score with vedolizumab versus placebo was 77·8% (95% CI 66·4 to 86·3; p<0·0001). Severe endoscopic recurrence was observed in ten (23·3%) of 43 patients in the vedolizumab group versus 23 (62·2%) of 37 patients in the placebo group (difference -38·9% [95% CI -56·0 to -17·3]; p=0·0004). Serious adverse events occurred in three (7·0%) of 43 patients who received vedolizumab (bilateral tubo-ovarian abscesses, thrombosed haemorrhoids, and pancreatic adenocarcinoma) and in two (5·4%) of 37 patients who received placebo (intestinal perforation related to Crohn's disease and severe abdominal pain). Vedolizumab treatment within 4 weeks of ileocolonic resection was more likely to prevent endoscopic Crohn's disease recurrence than placebo, making this an attractive option for postoperative management in patients with risk factors for recurrence. Larger studies with longer follow-up would be desirable. Takeda Nederland.

Summary of the Best Evidence for Postoperative Management of Breast Reconstruction Patients

To retrieve evaluate and summarize the best evidence regarding perioperative management in patients undergoing breast reconstruction thereby providing a reference and basis for clinical evidence based practice

Application of continuous nursing in the postoperative management of patients following coronary artery stenting

Application of continuous nursing in the postoperative management of patients following coronary artery stenting

Pain Scales: Types and Comparison

Objective: Pain is a common and significant symptom in clinical practice, particularly among emergency and cancer patients. This article explores various pain scales and their clinical applications, alongside postoperative pain management in oncologic patients. A review of unidimensional pain scales, including the Numeric Rating Scale (NRS), Visual Analog Scale (VAS), Verbal Rating Scale (VRS), and Faces Pain Rating Scale (FPS), is presented. Additionally, the pathophysiology and pharmacological and non-pharmacological strategies for managing postoperative pain in cancer patients are discussed. Pain scales vary in sensitivity, ease of use, and clinical suitability. NRS is widely preferred for its simplicity and statistical applicability, whereas VAS offers higher sensitivity but practical limitations. Postoperative pain in oncologic patients is influenced by surgical trauma, psychological factors, and pre-existing pain conditions, with inadequate management leading to systemic complications and increased cancer recurrence risk. Effective management incorporates both non-opioid and opioid analgesics based on pain severity. Pain assessment tools and effective management strategies are critical for improving patient outcomes in clinical settings. Tailored approaches, particularly in oncologic postoperative care, can mitigate complications and enhance quality of life.

Transdermal Fentanyl Patch Effectiveness in Postoperative Pain Management in Orthopedic Patients: Literature Review

Controlling pain after major orthopedic surgery may be challenging, and it is related to delayed recovery, the development of chronic pain, and analgesic dependence. It is well known that effective postoperative pain control can reduce hospital stays by ensuring a more rapid rehabilitation,thereby decreasing the overall costs. Despite the development of analgesics, the use of opioids and their derivates remains the cornerstone of treatment for patients with acute moderate-to-severe pain in association with general or regional anesthesia. To reduce the risk of side effects and opioid addiction, considering the alarming epidemiological reports in relation to opioid abuse, combined analgesic methods are used, in addition to lower dosages or different forms of administration, such as transdermal administration. Fentanyl transdermal patches appear to be effective in controlling postoperative pain as part of multimodal analgesic regimens in knee and hip surgery, shoulder arthroplasty, traumatic fractures, and one-day surgery; this treatment has fewer associated side effects and can be safely used even in patients with renal impairment. It is also recommended for postoperative pain management in combination with a femoral–sciatic nerve block during foot and ankle surgery.

Importance of timely diagnosis and intervention in uterine artery pseudoaneurysm caused by hysteroscopic surgery.

This manuscript explores the case on the occurrence of uterine artery pseudoaneurysm (UAP) during hysteroscopy endometrial polypectomy and the subsequent successful treatment via uterine artery embolization (UAE). Moreover, we focus on the management and treatment options for UAP in patients of advanced maternal age. A pseudoaneurysm is an extraluminal blood collection with a disrupted flow that communicates with the parent vessel via a defect in the arterial wall. The reported case involved a 48-year-old primiparous woman who developed a UAP after uterine polyp removal. The study enhances the understanding of UAP, a rare but potentially life-threatening condition, by providing a detailed and well-documented account of the comprehensive case presentation, effective use of medical imaging techniques for diagnosis, successful postoperative patient management following UAE, and practical clinical recommendations for clinicians managing similar cases. Overall, this study highlights the importance of considering UAP as a differential diagnosis in patients with abnormal vaginal bleeding following hysteroscopic surgery. Additionally, this manuscript recommends that clinicians with a high index of suspicion for UAP promptly request ultrasonography and computed tomography to facilitate early diagnosis. UAE is suggested as a primary treatment due to its effectiveness and safety, particularly in facilities capable of avoiding hysterectomy.

Postoperative pain management in patients with preexisting opioid dependence-A scoping review protocol.

Opioid-dependent patients with chronic pain conditions present a significant challenge for anesthesiologists when managing acute postsurgical pain. Opioid-dependent patients can experience tolerance, physical dependence, and hyperalgesia. These patients have an increased risk of poorly managed acute postoperative pain, which can ultimately lead to suffering and potentially an overall increase in length of hospitalization and healthcare cost. However, this is an under-researched field. This scoping review aims to investigate effective strategies in managing postoperative pain in patients with preexisting opioid dependence. A scoping review will be conducted on postoperative pain management in patients with preexisting opioid dependence. This review will be prepared according to the JBI methodology for scoping reviews and to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). We will conduct a comprehensive search across multiple databases. Backward citation searching of the final included articles will also be conducted. Data extraction will include trial and participant characteristics, intervention details, and reported outcomes. In the final review the results will be presented as a descriptive summary with supplementary tables, figures, and graphs where applicable. The planned scoping review will map out the current evidence about effective strategies to manage postoperative pain in patients with preexisting opioid dependence. We will aim to identify research gaps that can be used as support in the development of further research.

Practice Advisory for Postoperative Pain Management of Thoracic Surgical Patients: Executive Summary: A Report by Society of Cardiovascular Anesthesiologists.

Patients after thoracic surgery experience significant pain that can disrupt normal respiratory mechanics, increase the risk of respiratory complications, and impair recovery. Poorly controlled postoperative pain can develop into persistent postoperative pain. In addition, using opioids for pain control in the thoracic surgical population makes them more susceptible to opioid-related side effects due to their pre-existing comorbidities. The lack of consensus on how to effectively attain pain control in this surgical population has resulted in variability in the analgesic regimens utilized by providers across institutions and practices. The overall goal of this practice advisory is to identify opportunities for improvement in the postoperative pain management of thoracic surgical patients and provide guidance to perioperative providers through the provision of evidence-based recommendations.

Practice Advisory for Postoperative Pain Management of Thoracic Surgical Patients - A Report by Society of Cardiovascular Anesthesiologists

Practice Advisory for Postoperative Pain Management of Thoracic Surgical Patients - A Report by Society of Cardiovascular Anesthesiologists

Ultrasound-Guided Continuous Rhomboid Intercostal and Sub-Serratus Plane Block Comparison of Thoracoscopic Intercostal Nerve Block After Thoracoscopic Surgery: A Prospective Randomized Controlled Study.

Thoracic surgery is among the most painful surgeries, postoperative pain can lead to a poor prognosis. This study aimed to explore the analgesic effect of ultrasound-guided continuous rhomboid intercostal and sub-serratus (RISS) plane block Comparison of thoracoscopic intercostal nerve block (ICNB) on postoperative pain management and recovery in patients who underwent Video-Assisted Thoracic Surgery (VATS) Lobectomy. This prospective randomized controlled study enrolled patients after VATS Lobectomy who received ultrasound-guided continuous RISS plane block (RISS group) or ICNB (Control group) for postoperative pain. The primary outcome was the visual analogue scale (VAS) score. The secondary outcomes included non-invasive blood pressure (NIBP), heart rate (HR), the time to ambulation after surgery, the timing of drain removal, and the duration of postoperative hospitalization. A total of 98 participants were collected (53.08 ± 13.63; 43 (43.88%) males); each group included 49 patients. The RISS group displayed significantly lower visual analogue scale (VAS) scores during rest and when coughing at postoperative 12, 24, and 48h compared to the Control group (P < 0.001). The total consumption of sufentanil and remifentanil was smaller in the RISS group than in the control group. The NIBP,HR in the RISS group were significantly lower than in the Control group at immediately after skin incision (T1), upon entering the thoracic cavity (T2), 5min after entering the thoracic cavity (T3) (P < 0.001). The patients in the RISS group were more likely to exhibit a shorter time to the first postoperative ambulation compared to the Control group (8.84 ± 2.87,15.43 ± 4.50, P < 0.001). Continuous RISS may be a safe and effective strategy for postoperative pain management after thoracoscopic surgery.

Comparison of the Effect of Adding Dexmedetomidine as an Adjuvant to Bupivacaine for Postoperative Pain Management in Patients Undergoing Shoulder Rotator Cuff Repair – A Randomized Clinical Trial

Background: Shoulder rotator cuff repair postoperative pain management is more critical than orthopedic surgeries in other limbs. This study aimed to investigate the effect of adding dexmedetomidine as an adjuvant to bupivacaine for postoperative pain management. Materials and Methods: This double-blind, randomized clinical trial was performed on 80 patients aged 20 to 60 with ASA I and II who were candidates for elective shoulder rotator cuff repair. Forty candidates in the control group received 0.1% bupivacaine intra-articular and extra-articular before surgical wound closure, and 40 patients in the intervention group received 0.1% bupivacaine and dexmedetomidine 1 µg/kg intra-articular and extra-articular. Postoperative sleep disturbance and pain intensity were measured at recovery, 4, 8, 12, 18, and 24 hours after surgery. The results were analyzed by SPSS software version 23, and a P value ≤0.05 was considered significant. Results: There were no significant differences between the two groups regarding the hemodynamic variations (P &gt; 0.05), except 4 hours after surgery when the mean arterial pressure in the intervention group was significantly lower than the control group (P = 0.026). There was a significant reduction in pain scores at 8 and 12 hours after surgery in the intervention group. The night after surgery, sleep quality and the overall RCSQ score in the intervention group were significantly higher than those in the control group. Conclusion: Administering 0.1% bupivacaine and dexmedetomidine 1 µg/kg intra-articular and extra-articular before surgical wound closure effectively reduced the pain intensity and analgesic consumption. Also, it maintained patients’ hemodynamic stability and enhanced sleep quality without significant adverse effects.

Ultrasound-guided bilateral erector spinae plane block in the management of postoperative analgesia in living liver donors: a randomized, prospective study.

Living donor hepatectomy is a procedure associated with notable postoperative pain, impacting patient recovery and satisfaction. Addressing this challenge, we aimed to examine the effect of ultrasound-guided bilateral erector spinae plane block (ESPB) in postoperative analgesia management of patients undergoing living donor hepatectomy for liver transplantation. A single-center prospective, randomized, controlled study was conducted on ASA I-II patients aged 18-65 who underwent elective living donor hepatectomy. Participants were randomized into ESPB (N.=20) and control (N.=21) groups. ESPB was performed under ultrasound guidance with 0.25% bupivacaine (20 mL bilaterally) at T7-T9 levels. The control group received no block. Postoperative analgesia included IV acetaminophen, opioids, alongside fentanyl patient-controlled analgesia. Pain intensity was assessed using Numeric Rating Scale (NRS) at various time intervals. Primary outcome was to compare postoperative opioid consumption levels and secondary outcomes were to evaluate postoperative pain scores, requirement of rescue analgesia, and opioid-related side effects. Patients in ESBP group exhibited lower total fentanyl consumption (P=0.023) and lower meperidine use for rescue analgesia (P=0.001) compared to controls. While static pain scores showed no significant difference, Group ESPB reported lower dynamic pain scores in the immediate postoperative period (P=0.047). The incidence of nausea was lower in Group ESPB (6 vs. 17, P=0.002) with no observed complications. ESPB displayed promise in effectively managing post-living donor hepatectomy pain, resulting in decreased opioid consumption, improved pain relief, and reduced rescue analgesia requirements. This technique holds potential to enhance recovery and patient satisfaction following donor hepatectomy.

Nationwide medical database study for postoperative nutritional management in patients undergoing gastroenterological cancer surgery

Nationwide medical database study for postoperative nutritional management in patients undergoing gastroenterological cancer surgery

The Effects of Syphilis Infection on Total Knee Arthroplasty Outcomes: A Retrospective Cohort Study.

Objective: This study investigated the impact of recent syphilis infection on postoperative outcomes following total knee arthroplasty (TKA). We hypothesized that patients with a documented history of syphilis infection would experience a higher rate of postoperative complications compared to those without such a history. Methods: We conducted a retrospective cohort analysis using a national insurance claims database. Our study population included 237,360 patients who underwent primary TKA between 2005 and 2024. Patients were classified into two groups based on the presence (+Syph) or absence (-Syph) of a syphilis diagnosis within one year prior to the TKA. We evaluated the rates of several postoperative complications at 30 days postsurgery, including infection, hematologic issues, and cardiac events. Statistical analyses between groups was performed using chi-squared tests and Fisher's exact tests. Routine demographic data such as age, sex, race, and comorbidities were also analyzed. Results: Among the 237,360 TKA patients, we identified 71 with a history of syphilis within one year of their surgery. The +Syph group exhibited significantly higher rates of periprosthetic infection (4.23% vs. 0.81%, p = 0.001), need for manipulation under anesthesia (MUA) at four months (7.04% vs. 2.82%, p = 0.032), deep venous thrombosis (4.23% vs. 1.27%, p = 0.026), periprosthetic fracture (2.82% vs. 0.23%, p < 0.001), and pneumonia (2.82% vs. 0.62%, p = 0.019) within 30 days postTKA. No significant differences were observed in 30-day mortality, deep or superficial surgical site infections, wound dehiscence, blood loss anemia, or transfusion requirements. Additionally, rates of acute renal failure, pulmonary embolism, and cardiac events did not differ significantly between groups. Demographically, patients in the syphilis cohort had a higher prevalence of smoking and diabetes preoperatively within one year of their surgical date. Conclusions: A documented syphilis diagnosis within one year of TKA significantly affects postoperative outcomes, increasing the rates of prosthetic joint infection, MUA, deep venous thrombosis, periprosthetic fracture, and pneumonia. These findings underscore the need for heightened vigilance in the pre- and postoperative management of patients with a history of syphilis infection undergoing TKA. Further research is warranted to explore the relationship between prior syphilis infection and TKA outcomes, as well as to develop strategies to mitigate this increased risk.

Comprehensive analysis of single-cell and bulk RNA sequencing reveals postoperative progression markers for non-muscle invasive bladder cancer and predicts responses to immunotherapy

BackgroundNon-muscle-invasive bladder cancer (NMIBC) is renowned for its high recurrence, invasiveness, and poor prognosis. Consequently, developing new biomarkers for risk assessment and investigating innovative therapeutic targets postoperative in NMIBC patients are crucial to aid in treatment planning.ApproachesDifferential gene expression analysis was performed using multiple Gene Expression Omnibus (GEO) datasets to identify differentially expressed genes (DEGs) between NMIBC and normal tissue, as well as between NMIBC and muscle-invasive bladder cancer (MIBC). Functional enrichment analysis was conducted based on the DEGs identified. Subsequently, prognosis-related genes were selected using Kaplan–Meier (KM) analysis and Cox regression analysis. The Boruta algorithm was utilized to further screen for core DEGs related to postoperative progression in NMIBC based on the aforementioned prognosis-related genes. Single-cell and clinical correlation studies were performed to verify their expression across various stages of bladder cancer. To investigate the link between core genes and the immune microenvironment, single-sample gene set enrichment analysis (ssGSEA) was utilized, and Receiver Operating Characteristic (ROC) and KM analyses were performed to confirm predictive power for immune therapy outcomes. Machine learning (ML) models were constructed using the DepMap dataset to predict the efficacy of core gene inhibitors in treating bladder cancers. The prognostic performance of the core genes was evaluated using ROC curve analysis. An online prediction tool was developed based on the core genes to provide prognostic predictions. Finally, RT-qPCR, CCK-8, and Transwell assays were used to verify the pro-tumor effects of the GINS2 in bladder cancer.ResultsA total of 70 DEGs were identified, among which 11 prognostic genes were obtained through KM analysis, and an additional 8 prognostic genes were obtained through COX analysis. The Boruta algorithm selected AURKB, GINS2, and UHRF1 as the three core DEGs. Single-cell and clinical variable correlation analyses indicated that the core genes promoted the progression of bladder cancer. The analysis of immune infiltration revealed a strong positive association between the core genes and both activated CD4 T cells and Type 2 helper T cells. Two random forest (RF) models were constructed to effectively predict the treatment effect of bladder cancer after targeted inhibition of AURKB and GINS2. In addition, an online nomogram tool was developed to effectively predict the risk of postoperative progression in NMIBC patients undergoing TURBT. Finally, RT-qPCR, CCK8, and Transwell assays showed that GINS2 promoted the growth and progression of bladder cancer.ConclusionAURKB, GINS2, and UHRF1 have the potential to enhance postoperative management of NMIBC patients undergoing transurethral resection of bladder tumor (TURBT) and can predict immunotherapy response, establishing them as promising therapeutic targets.

QLTI-11. PREDICTORS OF PROLONGED LENGTH OF STAY IN LASER INTERSTITIAL THERMAL THERAPY FOR INTRACRANIAL PATHOLOGIES: A SINGLE CENTER EXPERIENCE

Abstract INTRODUCTION Laser interstitial thermal therapy (LITT) offers a minimally invasive approach for treating intracranial pathologies, often with shorter hospital stays than traditional craniotomies. Yet, some patients still face prolonged length of stay (PLOS), highlighting the need to identify contributing factors and improve post-LITT outcomes. OBJECTIVE To evaluate factors contributing to PLOS following LITT for intracranial pathologies. METHODS A retrospective review was conducted between 2013-2023 for patients undergoing LITT for intracranial pathology at a tertiary care center. PLOS was defined as discharge &amp;gt;2 days. Multivariate logistic regression analyzed variables as contributors to PLOS including ICU LOS (hours), preoperative maximum tumor diameter (cm), lesion location, lesion pathology (high grade glioma (HGG)/glioblastoma (GBM) vs. other), and mFI-11 score (binary ≥ or &amp;lt; 75th percentile). RESULTS The cohort consisted of 288 patients, with 29% (83/288) and 71% (205/288) having PLOS and non-PLOS, respectively. Mean age was similar between the PLOS (63-years) and non-PLOS (60-years) groups (p=0.09). The PLOS group had a 55% male predominance compared to 57% female in the non-PLOS group. Greater mFI-11 scores showed increased risk of PLOS [4.01, (2.11, 7.60), p&amp;lt;0.000]. Lesions having a subcortical location [3.43 (1.70, 6.95), p=0.001] or diagnosis of HGG or GBM [2.87 (1.54, 5.34), p=0.001] had increased risk of PLOS. Importantly, maximum pre-operative diameter did not significantly alter risk of PLOS [1.05 (0.98, 1.13), p=0.151]. CONCLUSION For the first time, we show that patient comorbidities, subcortical lesion location, HGG/GBM pathology, and greater time spent in the ICU portend increased risk of PLOS following LITT. Future work should validate our model with the goal of optimizing post-operative patient management and resource allocation.

Closed-incision negative pressure wound therapy (NPWT) in elderly patients following sacral pressure sore reconstruction

BackgroundPressure sores significantly affect elderly patients, with the sacrum being especially vulnerable, often due to its proximity to the anus and potential for fecal contamination. Despite preventive measures such as frequent repositioning and specialized cushions, some sores still necessitate surgical intervention. Postoperative care focuses on monitoring, hygiene, and pressure alleviation. This study assessed the efficacy of Closed-Incision Negative Pressure Wound Therapy (CI-NPWT) for postoperative wound management in patients with sacral pressure sores treated with local flaps.MethodsA retrospective analysis was performed on sacral sore patients who underwent reconstructive surgery from March 2019 through April 2023. Surgical procedures involved debridement and wound coverage using gluteal artery perforator-based fasciocutaneous flaps, followed by postoperative monitoring. Patients were grouped into conventional monitoring or NPWT management, with the latter utilizing the INFOV.A.C. The therapy unit was calibrated to 125 mmHg. Data on patient demographics, flap metrics, fluid drainage amounts, and six-month postoperative outcomes were collected, and then analyzed with SPSS Statistics.ResultsIn this study of 52 patients with sacral pressure sores, the NPWT group (n = 25) showed significantly fewer flap complications and a lower drainage volume on the seventh postoperative day (mean 17.2 cc) compared to the conventional dressing group (mean 27.8 cc, P < 0.05). No postoperative complications were observed in the NPWT group, whereas the conventional group (n = 27) experienced one infection and three cases of dehiscence. Both groups achieved a 100% flap survival rate.ConclusionClosed-incision negative pressure wound therapy (CI-NPWT) shows promise in reducing wound dehiscence and infection rates in elderly patients undergoing sacral pressure sore reconstruction with local flaps. However, further research with larger, randomized studies is needed to confirm its effectiveness as an alternative to conventional postoperative care.Trial registration.The study was retrospectively registered by the Institutional Review Board of Seoul Metropolitan Government-Seoul National University Boramae Medical Center (No. 20–2023–25, Date: Mar. 24 2023).

Postoperative management of pediatric patients undergoing single-stage laryngotracheal reconstruction in the United States: A survey of ASPO members

IntroductionThe postoperative management of single-stage laryngotracheal reconstruction (ssLTR) plays a significant role in the surgery's outcomes. The relatively prolonged period in which the child remains intubated and sedated to allow graft healing may be complicated by pulmonary sequelae, airway obstruction, withdrawal symptoms, and eventually failed extubation. This study aims to assess post-ssLTR practices among pediatric otolaryngologists. MethodAn electronic cross-sectional survey was distributed to the American Society of Pediatric Otolaryngology (ASPO) members to elucidate current protocols in post-ssLTR practice in the United States. ResultsEighty-six responses were recorded. A majority (60 %; n = 50) reported performing fewer than five ssLTRs per year. The mean time to bronchoscopy following ssLTR was postoperative day 8±3 for ssLTR with a posterior graft and postoperative day 7±3 without a posterior graft. Most practitioners reported avoiding paralytics (61 %, n = 44) unless the desired level of sedation could not be achieved. Most providers utilized pre-pyloric feeding via a nasogastric or gastrostomy tube (n = 50, 72 %). A total of 70 % (n = 49) of respondents use a single medication for acid suppression, whereas 21 % (n = 15) reported dual-acid suppression whether the patient was diagnosed with gastroesophageal reflux prior to surgery or not, regardless of feeding route. Nebulized agents were routinely used, with normal saline (43 %; n = 36) being the most reported agent. ConclusionThe postoperative management after ssLTR varies greatly among pediatric otolaryngologists due to a lack of evidence-based data to support one protocol over the other. Multi-institutional studies should be considered to evaluate current protocols and improve postoperative care.