Postoperative Satisfaction Scores Research Articles

Treatment Algorithm for Surgical Correction of Lower Eyelid Bags and Tear Trough Deformity Based on Barton Grading System.

Facial rejuvenation procedures for lower eyelid bags and tear trough deformity have recently gained increasing attention. This study introduced a treatment algorithm tailored to the severity of tear trough deformity, categorized using the Barton grading system, to tackle this concern effectively. One hundred seventy-six patients with combined lower eyelid bags and tear trough deformity underwent lower lid blepharoplasty at our center between 2018 and 2023. Preoperative assessment utilized the Barton grading system to categorize the severity of tear trough deformity, guiding personalized surgical approaches for each patient. Postoperative outcomes, including satisfaction levels, complications, and tear trough deformity improvement, were evaluated. Following surgery, 175 out of 176 patients achieved a reduction to Barton grade level of 0. Postoperative satisfaction scores averaged 4.4, with a satisfaction rate of 96.6%. Complications were minimal, including mild postoperative ectropion in patients and single occurrences of postoperative hematoma, infection, insufficient improvement, and recurrence. Our treatment algorithm offers a straightforward and effective approach for addressing tear trough deformity and lower eyelid bags. Further research is warranted to validate these findings.

The sandwich technique used for correction of pectus carinatum combined with Harrison sulcus

We aimed to investigate the feasibility of the sandwich technique to treat pectus carinatum combined with Harrison sulcus. We retrospectively analysed the clinical data of 38 paediatric patients with pectus carinatum combined with Harrison sulcus treated from June 2015 to October 2022. All the patients underwent surgery using the sandwich technique. The surgical conditions and postoperative outcomes of the patients and the satisfaction score of family members were analysed. Overall, the patients had a mean duration of surgery of 179.05 ± 36.01 min, intraoperative blood loss of 10.03 ± 2.77 mL, postoperative hospital stay of 6.89 ± 0.73 days, and postoperative satisfaction score of 89.4 ± 4.6. The incidence of surgical complications was 7.89%. The internal fixation stents were removed in 22 patients, and there was no recurrence during a follow-up 371.4 ± 6.3 days post-stent removal. These results were satisfactory. The use of the sandwich technique to treat this condition does not reduce the volume of the thorax after the procedure and results in an aesthetically pleasing incision, less complications, and fast postoperative recovery. Thus, it is a safe and effective method that is worthy of being promoted for clinical application.

Comparison of short-term clinical results between modified kinematically-aligned and guided motion bicruciate stabilized total knee arthroplasty

BackgroundBoth kinematically-aligned (KA) total knee arthroplasty (TKA) and bicruciate stabilized (BCS) TKA aim to reproduce the physiological knee kinematics. In this study, we compared the femoro-tibial component rotational mismatch between patients who underwent modified KA-TKA and those who received guided-motion BCS-TKA, and its influence on the clinical outcomes.MethodsIn this retrospective study, 77 consecutive patients were included and divided into two groups: subjects who underwent modified KA-TKA with Persona (KA Group; n = 42) and those who received BCS-TKA with JOURNEY II (BCS group; n = 35). Range of motion, the 2011 Knee Society Score (KSS), the rotational alignment of the femoral and tibial components, and the correlations between the rotational mismatch and the 2011 KSS subscales were examined.ResultsThe postoperative objective knee indicators (P = 0.0157), patient satisfaction (P = 0.0039) and functional activity scores (P = 0.0013) in the KA group were significantly superior to those in the BCS group 1 year postoperatively. There was no significant difference between the two groups observed in the rotational mismatch. In the BCS group, significant negative correlations were identified between the rotational mismatch and objective indicators, patient satisfaction, and functional activity scores but not in the KA group.ConclusionsThe short-term clinical results following KA-TKA showed superior objective knee indicators, patient satisfaction and functional activity scores. A negative correlation was observed between component rotational mismatch and the 2011 KSS subscales in the BCS group, compared to no relationship found between the two in the KA group. These findings suggested that KA-TKA has a relatively higher tolerance for rotational mismatch than BCS-TKA.

Effectiveness and safety of multimodal analgesia in open gastrostomy in patients with end-stage head and neck cancer

Objective: To investigate the effectiveness and safety of multimodal analgesia in patients with end-stage head and neck cancer in open gastrostomy surgery. Methods: This was a randomized controlled trial. From June to December 2023, 50 patients with end-stage head and neck cancer who underwent elective open gastrostomy surgery in Beijing Tongren Hospital Affiliated to Capital Medical University were prospectively selected. The patients were divided into multimodal analgesia group and local anesthesia group using the random number table method according to different anesthesia methods, with 25 cases in each group. In multimodal analgesia group, a multimodal analgesia regimen was adopted: ultrasound-guided abdominal wall nerve block (rectus sheath block and transverse abdominis plane block)+intravenous injection of oxycodone+intravenous injection of flurbiprofen axetil and dexamethasone. In local anesthesia group, local infiltration anesthesia with ropivacaine was adopted. The main outcome measure was the incidence of intraoperative pain numeric rating scale (NRS) score>3 points in the two groups. The secondary observation indicators included NRS score and hemodynamic indexes [mean arterial pressure (MAP) and heart rate (HR)] at various time points during surgery [before anesthesia (T0), at the time of incision (T1), 10 minutes after surgery (T2), during gastric body traction (T3), and at the end of surgery (T4)], incidence of adverse reactions, postoperative patient satisfaction score, as well as the NRS scores at rest and activity (coughing) within 24 hours after surgery. Results: The multimodal analgesia group included 21 males and 4 females, aged (61.4±9.9) years. There were 19 males and 6 females in the local anesthesia group, aged (58.6±10.8) years. The incidence of intraoperative NRS score>3 points and the incidence of salvage analgesia in the multimodal analgesia group were both 12.0% (3/25), which were lower than 60.0% (15/25) in the local anesthesia group, and the differences were statistically significant (all P<0.001); The NRS score [M (Q1, Q3)] at T3 in the multimodal analgesia group was 2 (2, 3) points, which were lower than 5 (3, 6) points in the local anesthesia group (P<0.05). There were smaller variabilities in MAP and HR in the multimodal analgesia group than those in the local anesthesia group (all P<0.05). The incidence of intraoperative tachycardia, surgical traction reaction, and nausea in the multimodal analgesia group was lower than that in the local anesthesia group (all P<0.05). The postoperative satisfaction score of patients in the multimodal analgesia group was (9.25±0.71) points, which were higher than (7.33±0.87) points in the local anesthesia group (P<0.001). NRS score during postoperative activity within 24 hours in the multimodal analgesia group were (2.36±0.75) points, which were lower than (3.03±0.81) points of the local anesthesia group (P=0.005). No adverse reactions such as urinary retention, nausea, vomiting and dizziness occurred in both groups. Conclusion: Compared with local anesthesia, the multimodal analgesic strategy could provide better analgesic effect and longer duration, better hemodynamic stability, and fewer intraoperative adverse reactions in patients with end-stage head and neck cancer undergoing open gastrostomy.

No difference in postoperative patient satisfaction rates between mechanical and kinematic alignment total knee arthroplasty: A systematic review.

The purpose of this systematic review was to compare patient satisfaction patient-reported outcomes (PROMs) levels after mechanically aligned (MA) and kinematically aligned (KA) total knee arthroplasty (TKA). A systematic literature search following PRISMA guidelines was conducted on PubMed, Embase, Medline and Scopus to identify potentially relevant articles for this review, published from the beginning of March 2013 until the end of October 2023. Only articles reporting satisfaction after KA TKA, MA TKA or both were included, which use valid and reliable tools for the evaluation and reporting of satisfaction after TKA. Title, authors, year of publication, study design, level of evidence, follow-up period, patients' demographic data, sample size, type of satisfaction score, postoperative satisfaction score, postoperative alignment, statistical significance, as well as other variables, were extracted for analysis. An Agency for Healthcare Research and Quality's (AHRQ) design-specific scale was used for assessing randomized control trials (RCTs). The nonrandomized control trials were evaluated by using the Joanna Briggs Institute's (JBI) Critical Appraisal Tool. The Newcastle-Ottawa Scale (NOS) was also used to assess cohort studies, while case series were evaluated using the NIH Quality Assessment Tool for Case Series Studies. The initial search identified 316 studies, of which 178 were considered for screening. Eleven studies completely fulfilled the inclusion criteria, including one RCT, five nonrandomized control trials/quasi-experiments, three case series, and two cohort studies. The total number of patients recruited for MA TKA was 1740. Conversely, 497 patients were enrolled for KA TKA. Five studies used the visual analogue scale (VAS) for assessing postoperative patient satisfaction, four used the Knee Society Score (KSS) 2011 version and two Likert-based types of scores. Overall, the highest mean satisfaction score of KSS 2011 was 31.5 ± 6.6 in the MA group, and 29.8 ± 80 in the KA group in four studies. All of them showed high postoperative patient satisfaction rates for both MA and KA TKA, but with no statistically significant difference between them (p > 0.05). Both mechanically aligned total knee arthroplasty, as well as kinematically aligned total knee arthroplasty led to high rates of postoperative patient satisfaction, with no statistically significant differences between them. Level III, systematic review.

Functional Outcomes and Satisfaction Rates in Patients Aged 80 Years or Older are Not Clinically Different From Their Younger (65 to 75 Years) Counterparts Following Total Hip Arthroplasty

BackgroundAs the population ages, the proportion of elderly patients requiring total hip arthroplasty (THA) increases, but it is not clear whether older age independently influences outcome. The aim was to assess function, quality of life, and satisfaction after THA in patients ≥ 80 years compared with those aged between 65 and 75 years when adjusting for confounding factors. MethodsA single-center retrospective cohort study was performed between 2010 and 2019. A total 2,367 THAs were performed on patients ≥ 80 years and 5,113 on patients aged 65 to 75 years. The demographic data and length of stay (LOS) were recorded. Preoperative and 2-year postoperative Oxford Hip Scores (OHS), EuroQol (EQ-5D), and satisfaction scores were collected. Clinically meaningful difference was defined as 5 points in OHS and utility of 0.085 in EQ-5D. Regression analyses were performed to adjust for confounding factors. ResultsPatients in ≥ 80-years group were more likely women (P < .001), have higher American Society of Anesthesiolgists grade (P < .001), worse preoperative OHS (mean difference [MD] 2.3, P < .001), and EQ-5D (MD 0.087, P < .001). Both age groups achieved clinically meaningful and statistically significant (P < .001) improvement in OHS and EQ-5D utility at 2 years. When adjusting for confounding variables, the ≥ 80-year-old group had significantly (P < .001) lower improvement in OHS (MD -1.9 points) and EQ-5D (MD −0.055 utility), but these differences were not clinically meaningful. There was no difference (P = .813) in satisfaction between the groups. When adjusting for confounding variables, ≥ 80-year-old group had increased risk of longer LOS (odds ratio 1.27, P < .001). ConclusionsThere were no clinically meaningful differences in hip-specific outcome or health-related quality of life according to age group, and both were equally satisfied with their outcome. The older age group did, however, have longer LOS. Level of evidenceLevel III retrospective cohort study.

Responsiveness and validity of the Normal Hand Score in patients undergoing carpal tunnel decompression.

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Outcome of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society outcome questionnaire

Background Adolescent idiopathic scoliosis (AIS) is a structural deformity of the spine. Posterior deformity correction represents the gold standard of the surgical treatment of AIS. The fixation technique was shifted from hybrid fixation to the all pedicle screw construct, which could produce superior deformity correction. Patient-oriented outcome questionnaires have become an important measure of the success of surgical correction. This study was conducted to assess the outcome of all pedicle screw constructs in treating AIS using the Scoliosis Research Society (SRS)-24 outcome questionnaire. Patients and methods Seventy-nine AIS patients were included with a minimum 2-year follow-up. Clinical and radiographic measurements were evaluated at preoperative, postoperative, and final follow-up periods. Complications and results of the SRS-24 questionnaire were analyzed. Sex, Lenke classification, levels of the lowest instrumented vertebra, curve magnitude, and percentage of curve correction were correlated with the SRS-24 questionnaire results. Results There were 59 females and 20 males. The mean age of the patients was 14.2 ± 2.5 years. According to Lenke classification, the majority of the curves were type 1 (57 patients), followed by type 5 (11 patients), type 2 (six patients), type 3 (three patients), type 6 (two patients), and no type 4. The mean preoperative major curve Cobb angle was 59.3 ± 9.045° and the mean postoperative Cobb angle was 5.82 ± 5.932°. The average score for SRS-24 was 4.17. The mean preoperative pain score was 3.29, which improved to 4.30 after at least 2 years of follow-up (P˂0.005). Statistically significant improvement was seen in the general self-image, function from back condition, and level of activity. After surgery, the mean score for self-image was 4.19, and for function was 3.55. The postoperative function was the lowest, while the postoperative satisfaction score was the best of all domains, with a mean score of 4.55. About 90% of patients were satisfied with the results of their surgical correction. Magnitude of curve and amount of correction did not significantly alter the SRS scores. Conclusion All pedicle screw construct is an efficient and safe method in AIS correction. The surgical treatment in our AIS patients has resulted in a perceived benefit in all domains of SRS-24 questionnaire.

Anatomic shoulder arthroplasty: the correlation between patient resilience, mental health, and outcome

Recovery from anatomic shoulder arthroplasty may be enhanced in patients with good mental health and the resilience to participate in the prescribed postoperative rehabilitation program. To test this concept, we utilized validated and reliable scales in determining whether resilience and mental health are associated with the outcome of anatomic arthroplasty. 399 patients (195 ream and run (RnR) and 204 anatomic total shoulder (aTSA)) were surveyed at a mean follow-up of 6.3 ± 3.3 years. Preoperative variables included age, sex, body mass index (BMI), history of prior shoulder surgery, diabetes, visual analog scale for pain (VAS), Simple Shoulder Test (SST) scores, and Veteran's RAND-12 Mental Component Score (VR-12 MCS). Outcomes collected included the SST, American Shoulder and Elbow Surgeons Score (ASES), revision rate, and patient satisfaction. Resilience was documented using the Connor Davidson Resilience Scale-10 (CD RISC-10) at latest follow-up. Univariable and multivariable regression analyses were used to identify factors significantly associated with follow-up postoperative SST, ASES and satisfaction. In the univariable analysis, CD RISC-10 was positively correlated with postoperative SST, ASES and satisfaction after both RnR and aTSA. Mean CD RISC-10 scores were higher in the RnR cohort (34.3 ± 4.8 vs. 32.5 ± 6.2 for aTSA, p<0.001). Male sex and lower preoperative VAS were correlated with higher ASES after RnR; VR-12 MCS was positively correlated with all outcomes except SST after RnR. In the multivariable linear regression analysis, CD RISC-10 was independently associated with postoperative SST, ASES and satisfaction scores in aTSA patients. In the RnR cohort, CD RISC-10 was only correlated with satisfaction. VR-12 MCS was correlated with ASES and satisfaction after RnR. In this study of anatomic arthroplasties, increased resilience and better mental health were correlated with better outcomes. RnR patients had higher resilience than aTSA patients. Greater resilience was associated with better outcomes after anatomic total shoulder arthroplasty. Better mental health was associated with superior outcomes after the ream and run procedure.

Clinical analysis of a new multifunctional instrument set for gasless endoscopic thyroidectomy with two different approaches

BackgroundFollowing the rapid development of endoscopic thyroidectomy techniques, various surgical procedures have been developed (e.g., transoral, submandibular, areolar, axillary, retroauricular, and combined procedures), and each of these procedures has its own advantages. In recent years, gasless endoscopic thyroidectomy has emerged as a feasible procedure, and it has replaced traditional CO2 insufflation approaches because of advantages such as stable cavity construction, pollution reduction, resource saving, and risk reduction. However, each gasless procedure requires special instruments for cavity construction, and this results in enormous wastage of medical resources. In the present study, we introduced a set of instruments developed by our team. This set of instruments is designed to be compatible with the current gasless endoscopic thyroidectomy approaches, including transoral, submandibular, transareolar, transaxillary, retroauricular, combined, and lateral cervical lymph node dissection. Here, we introduced this set of instruments for two gasless endoscopic thyroidectomy procedures (transaxillary and transareolar). Following the incorporation of this set of instruments in regular clinical practice, it could be used for more gasless endoscopic thyroidectomy procedures in the future.ObjectiveTo investigate the feasibility, safety, and efficacy of the self-developed instruments for gasless endoscopic thyroidectomy in two different approaches.MethodsA total of 180 patients diagnosed to have papillary thyroid carcinoma (PTC) between January 2020 and April 2022 were retrospectively investigated. The patients were assigned to a gasless transaxillary group (group A) and a gasless transareolar group (group B). The same gasless endoscopic-assisted instruments were used for both groups. The clinical characteristics, treatment results, and complications were compared between the two groups.ResultsAll 180 patients were successfully operated. The extent of surgical resection in all patients was the same: “unilateral glandular lobectomy + isthmus combined with ipsilateral central zone lymph node dissection.” There were 130 and 50 patients in group A and group B, respectively; one patient in the former group was converted to open surgery due to intraoperative bleeding. No significant difference was observed between the two groups in terms of gender, age, body mass index (BMI), education level, and proportion of concomitant Hashimoto’s thyroiditis (P > 0.05). The establishment of cavity time was significantly longer in group A than in group B (35.62 ± 5.07 min vs. 17.46 ± 2.55 min, P < 0.01). The number of lymph nodes cleared was slightly less in group A than in group B (4.06 ± 2.93 vs. 4.52 ± 2.38, P = 0.07). Moreover, the two groups showed no significant differences (P > 0.05) in the total operative time (145.54 ± 45.11 min vs. 143.06 ± 46.70 min), tumor size (0.68 ± 0.46 cm vs. 0.71 ± 0.49 cm), postoperative hospital stay (4.08 ± 1.48 days vs. 3.72 ± 1.07 days), vocal cord paralysis [4 (3.1%) vs. 2 (4%)], postoperative swallowing discomfort [24 (18.5%) vs. 5 (10%)], and postoperative recurrence and satisfaction scores (3.27 ± 1.52 vs. 3.28 ± 1.53).ConclusionAlthough the two approaches of gasless endoscopic surgery have different operative paths and different time periods for cavity construction, both approaches are similar in terms of the principle of cavity construction, safe and reliable postoperative efficacy, and good cosmetic effect. Therefore, the same set of instruments can be used to complete the surgery in both approaches, thus saving medical resources and facilitating the popularization of this technology.

Staged breast reconstruction utilizing primary nipple repositioning surgery prior to nipple-sparing mastectomy

Staged nipple-sparing mastectomy (NSM) following mastopexy or breast reduction has become increasingly utilized in patients with large or ptotic breasts. The safety and efficacy of this approach has been demonstrated in recent years. However, the optimal timing between stages has not been established. The authors provide their experience with this staged approach with emphasis on timing between stages. An institutional review board approved this retrospective study. Data of all patients at a single institution who underwent staged NSM following mastopexy or reduction mammaplasty for therapeutic or prophylactic oncologic surgical management from 2016 to 2020 were reviewed. Timing between stages as well as surgical, oncologic, aesthetic, and patient-reported outcomes were evaluated. Nineteen patients (38 breasts) underwent staged NSM following planned mastopexy/breast reduction. The mean time interval between stages was 25weeks. No patients developed nipple areolar complex necrosis. Infection and hematoma were seen in one breast (2.6%) and seroma in two (5.3%) after NSM. Delayed wound healing was seen in eight breasts (21.1%) after first stage mastopexy/reduction and in 12 breasts (31.6%) after NSM. Skin flap necrosis was noted in two breasts (5.3%) after NSM. No patients developed oncological recurrence. Mean patient-reported post-operative satisfaction and well-being scores were 63 and 67 out of 100, respectively. The authors describe their experience with staged NSM following nipple repositioning procedures. Their results suggest that this procedure can be performed safely with cosmetically favorable results if surgeons wait an average of 25weeks between first and second stage procedures.

Comparison of three different prophylactic treatments for postoperative nausea and vomiting after total joint arthroplasty under general anesthesia: a randomized clinical trial

BackgroundPostoperative nausea and vomiting (PONV) after total joint arthroplasty is common and associated with delayed recovery. This study was performed to evaluate the efficacy of three different prophylactic regimens for PONV after total joint arthroplasty under general anesthesia.MethodsPatients undergoing primary total hip or knee arthroplasty were randomized to Group A (ondansetron), Group B (10 mg dexamethasone plus ondansetron and mosapride), or Group C (three doses of 10 mg dexamethasone plus ondansetron and mosapride). The primary outcome was the total incidence of PONV during postoperative 48 h. The secondary outcomes were complete response, rescue antiemetic treatment, opioid consumption, time until first defecation, postoperative appetite score, satisfaction score, length of hospital stay, blood glucose level, and complications.ResultsPatients in Group C experienced a lower incidence of total PONV (29.3%, p = 0.001) and a higher incidence of complete response (70.7%, p = 0.001) than did patients in Group A (51.9%, 48.2%, respectively). Patients in Group C also experienced a lower incidence of severe PONV (4.3%) than patients in Group A (25.9%, p<0.001) and B (20.4%, p<0.001). Moreover, less rescue antiemetic treatment (1.4 ± 0.5 mg Metoclopramide) and postoperative opioid consumption (1.8 ± 0.3 mg Oxycodone, 6.0 ± 1.0 mg Pethidine) was needed in Group C. Additionally, a shorter time until first defecation, shorter length of stay, and better postoperative appetite scores and satisfaction scores were detected in patients in Group C. A slight increase in the fasting blood glucose level was observed in Group C, and the complications were comparable among the groups.ConclusionCombined use of ondansetron, mosapride and three doses of dexamethasone can provide better antiemetic effectiveness, postoperative appetite, bowel function recovery, and pain relief than a single dose or ondansetron only.Trial registration informationThe protocol was registered at the Chinese Clinical Trial Registry (ChiCTR1800015896, April 27, 2018).

Utility of laparoscopic hysterectomy compared to vaginal and abdominal hysterectomy for benign gynecological conditions

In spite of availability of procedures which are less invasive for hysterectomy, some prefer abdominal approach for the hysterectomy (TAH). Laparoscopic hysterectomy (TLH) is useful for the patients, as they recover fast and the convalescence period is reduced.To compare and evaluate three different methods of hysterectomy for benign gynecological disorders with regard to time for recovery, outcome after surgery, cost-effectiveness and complications due to surgery.Prospective study conducted on 90 patients who underwent hysterectomy for benign gynecological conditions. Patients were assigned to either TAH (n=30), TLH (n=30) or Vaginal hysterectomy (VH) (n=30), with or without salpingo-oophorectomy. All patients presenting in the gynecology OPD with indications for hysterectomy with or without salpingo-oophorectomy were included. Pre-operative parameters like age, basal metabolic index, intra-operative and post-operative parameters like reduction in hemoglobin etc. were compared in three groups.The mean blood loss, Time from surgery to tolerance of normal diet (days), Time from surgery to unassisted ambulation (days), post-operative pain score on day 3, mean reduction in hemoglobin and duration of hospital stay (days) were significantly (p&amp;#60;0.05) higher in patients who underwent total abdominal hysterectomy compared to total laparoscopic or vaginal hysterectomy. In terms of intra-operative and post-operative complications, operative time, hospital bill and satisfaction score the differences were not significant statistically (p&amp;#62;0.05). Total laparoscopic hysterectomy and vaginal hysterectomy are safe and less invasive alternative, compared to abdominal hysterectomy, and show significantly better post-operative reconstitution

Radiofrequency Ablation and Microdebrider-Assisted Turbinoplasty: 5-Year Postoperative Outcomes

Background and Objectives: Turbinoplasty may be an option in patients with persistent symptoms of allergic rhinitis (AR) despite adequate medication. The two most frequently used surgical techniques for turbinoplasty are radiofrequency ablation and microdebriderassisted turbinoplasty. This study compared the outcomes of these two surgical techniques and assessed the long-term treatment effects.Methods: This study included patients with AR who underwent turbinoplasty between January 2010 and June 2017. We examined the medication scores, overall treatment satisfaction scores, and medical records. Based on the type of surgery, patients were classified into microdebrider and coblator groups. A telephone survey was conducted to collect data on the 5-year post-treatment efficacy parameters. Scores for allergic symptoms, prescription medicines taken after surgery, and general satisfaction were compared.Results: Of the total 241 patients, 192 (79.7%) and 49 (20.3%) underwent microdebrider-assisted turbinoplasty and radiofrequency ablation turbinoplasty, respectively. Both the microdebrider and coblator groups showed remarkable improvements in AR symptoms at the 5-year follow-up (p&lt;0.001). Although the degree of symptom improvement did not differ significantly between the two groups, the coblator group did show significant improvements in medication scores when compared with the microdebrider group (p&lt;0.05), and there were significant differences in postoperative satisfaction scores between the two groups.Conclusion: In terms of 5-year postoperative outcomes, radiofrequency-ablation turbinoplasty and microdebrider-assisted turbinoplasty were equally beneficial for reducing nasal symptoms and enhancing medication ratings in patients with AR.

Complication rates and efficacy of single-injection vs. continuous interscalene nerve block: a prospective evaluation following arthroscopic primary rotator cuff repair without a concomitant open procedure

To compare the complications and efficacy of pain relief of the interscalene anesthetic block using either a single-injection (SI) vs. a continuous, indwelling catheter (CIC) for arthroscopic rotator cuff repair surgery. Patients undergoing primary, arthroscopic rotator cuff repair without concomitant open procedure or biceps tenodesis were prospectively enrolled by 4 fellowship-trained sports medicine and shoulder surgeons. Patients received either a SI or CIC preoperatively based on surgeon preference. Patients were contacted by phone to complete a standard questionnaire on postoperative days (PODs) 1, 3, 7, 14, and 28. Patients were asked to rate the efficacy of their subjective pain relief (scale of 0-10), document issues with the catheter, describe analgesic usage, and report pharmacological and medical complications. The primary outcome was measured as complication rate. Postoperative narcotic use, patient satisfaction, and visual analog scale pain scores were measured as secondary outcomes. Seventy patients were enrolled, 33 CIC patients (13 male, 20 female, mean age 61±8 years) and 37 SI patients (20 male, 17 female, mean age 59±10 years). There were significantly more injection/insertion site complications in the CIC group (48%) vs. the SI group (11%, P=.001). The incidence of motor weakness was higher in the CIC group on POD 1 (P=.034), but not at any subsequent time points. On POD 1, CIC patients had a clinically significantly lower pain score compared to SI (3.2 vs. 5.4; P=.020). Similar scores were observed at subsequent time points until POD 28, when CIC again had a lower pain score (0.8 vs. 2.7; P=.005). However, this did not reach clinical significance. All patients in both groups rated a satisfaction of 9 or 10 (scale 0-10) with the anesthesia provided by their nerve block. CIC interscalene nerve blocks had an increased risk for injection site complications and minor complications in the immediate postoperative period when using the CIC for arthroscopic rotator cuff repair without any concomitant open procedures. CIC blocks demonstrated clinically significant superior pain relief on POD 1 but were equal to SI blocks at every time point thereafter. Superior pain relief of CIC at POD 28 was not clinically significant. CIC catheters do not appear to markedly decrease the use of postoperative narcotics. Despite this trend in complication rates and pain scores, all patients in both groups were satisfied with their nerve block.

Evaluating Predictors of Patient Satisfaction With Facial Appearance After Mohs Micrographic Surgery Using the FACE-Q.

Although patient satisfaction with reconstructive outcomes after facial skin cancer resection is an important consideration in Mohs surgery, there is limited information evaluating this concern using validated patient-reported outcome tools. To characterize predictors that may be associated with increased postoperative patient satisfaction with facial appearance after Mohs surgery using the FACE-Q/Skin Cancer survey, a patient-reported outcome tool that has been validated in various studies. A total of 202 patients who underwent Mohs surgery for facial skin cancer at the Brigham and Women's Faulkner Hospital between April 2017 and November 2021 were included after completing the postoperative Satisfaction with Facial Appearance scale (FACE-Q scale). Male patients were significantly more likely to have higher satisfaction scores compared with female patients (aOR 2.4, 95% CI 1.1-5.1). Increased preoperative facial satisfaction scores was directly correlated with increased postoperative facial satisfaction scores ( p < .01). Patients with tumors on the lower face/neck (aOR 3.88; 95% CI 1.4-10.7) had significantly greater satisfaction scores compared with those with tumors on their nose/nasolabial folds. Potential interventions and counseling methods can be tailored toward specific patient populations with lower satisfaction scores to increase their overall satisfaction with reconstructive outcomes.

Metaphyseal Metal Sleeves for Reconstruction of Severe Knee Bone Defects: Excellent Survival Rate at a Mean Follow-Up of 6.4 Years.

Management of bone loss in complex primary and revision total knee arthroplasty is key to the surgeries. Metaphyseal metal sleeves have been increasingly used recently to reconstruct severe knee metaphyseal bone defects. This study aimed to investigate the outcomes of the metaphyseal sleeve reconstructing Anderson Orthopedic Research Institute (AORI) type II and type III bone defects of knee joint. From 2014 to 2019, a total of 44 knees were enrolled in this clinical retrospective study after the screening, including seven cases of primary TKA and 37 cases of revision TKA. The types of bone defects involved in this study were AORI types II and III, and did not involve AORI type I bone defects. Patients' knee function preoperatively and postoperatively as well as quality of life were recorded and analyzed. Analysis included the American Knee Society Score (KSS), hospital for special surgery knee score (HSS), the Western Ontario and McMaster Universities (WOMAC) index, the Short Form 12 (SF-12) health survey, visual analogue scale score, and radiographic assessment with a mean follow-up of 6.4 years. Paired t-tests were used to determine the significance of changes in clinical scores and knee mobility. A mean follow-up of 77.2 (±17.6, standard deviation [SD]) months was performed, and none of the patients underwent knee revision for infection or aseptic loosening. At the last follow-up, the KSS knee score changed statistically from 37.1 (±19.7) preoperatively to 86.5 (±13.6, SD, p < 0.001) postoperatively and the KSS function score from 32.7 (±24.0) preoperatively to 78.3 (±15.6, SD, p < 0.001) postoperatively. The knee mobility improved from a mean of preoperative 72.61° (±33.42°, SD) to 108.52° (±24.15°, SD, p < 0.001). Postoperative radiographs showed that the host bone was tightly integrated with the metaphyseal metal sleeve, and there was no obvious translucent line formation around the sleeve. Of the patients, 86.4% had a postoperative satisfaction score ≥8 (10-point scale). At the mean follow-up of 6.4 years, the survival rate of the metaphyseal sleeves was 100%. Metaphyseal sleeves combined with cementless stems is an excellent and viable option for reconstruction of AORI type II and type III bone defects of the knee.

Comparison of the Postoperative Analgesia Effects of Patient-Controlled Analgesia and Epidural Catheter After Posterior Instrumentation Surgery

Objective: To prospectively assess the effects of intravenous patient-controlled analgesia (IV PCA) and epidural patient-controlled analgesia (epidural PCA) on postoperative pain management following posterior instrumentation surgery.&#x0D; Materials and Methods: The study involved the ASA 1-2 group, 60 patients who underwent elective thoracic or lumbar posterior instrumentation surgery at our tertiary centre for spinal stenosis. Two groups of patients were created: Group 1 (n = 30), IV PCA group, and Group 2 (n=30), epidural PCA group. IV PCA was applied by fentanyl. Epidural PCA was maintained by lading to epidural space by the neurosurgeon. Bupivacaine was administered to Group 2 patients in the recovery room. Following surgery, patients in both groups were assessed for pain using the visual analogue scale (VAS) and for motor block using the Bromage scale. Additionally, hemodynamic parameters, side effects, and patient satisfaction were noted. Following 48 hours, patients' overall rescue analgesia, opioid, and local anaesthetic requirements were recorded. &#x0D; Results: Postoperative VAS scores of Group 2 at the 1st, 2nd, 4th, 8th and 16th hours were lower than Group 1 and these differences was statistically significant. Postoperative patient satisfaction scores at 1st, 2nd, 4th, 8th, 12th, 16th, 20th, 24th, 30th, 36th, 42nd and 48th hours were significantly different between the groups and the patient satisfaction scores of Group 2 were higher than the Group 1. Side effects were similar in both groups. Group 1 required statistically significantly higher number of rescue analgesia. &#x0D; Conclusion: This study shows that epidural PCA is more comfortable than IV PCA with low VAS and high patient satisfaction scores. As a conclusion, epidural PCA is a safe, highly efficient method for patients with posterior instrumentation surgery.

Preoperative Patient-Reported Outcomes Predict Postoperative Clinical Outcomes Following Rotator Cuff Repair

To determine whether preoperative patient-reported outcomes (PROs) predict postoperative PROs and satisfaction following rotator cuff repair. We retrospectively identified patients who underwent a primary rotator cuff repair at a single institution. A receiver operating characteristics analysis was used to reach a preoperative American Shoulder and Elbow Surgeons (ASES) score threshold predictive of postoperative ASES and satisfaction scores. We evaluated patients above and below the receiver operating characteristics threshold by comparing their final ASES scores, ASES change (Δ) from baseline, percent maximum outcome improvement, and achievement of minimum clinically important differences, substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS). Fischer exact tests were used to analyze categorical data, and continuous data were analyzed using t-test. A total of 348 patients who underwent rotator cuff repair were included in this study. The preoperative ASES value predictive of achieving SCB was 63 (area under the curve, 0.75; 95% confidence interval: 58-67; P < .001). Patients with preoperative ASES less than 63 were significantly more likely to achieve MCID (odds ratio [OR]: 4.7, P < .001) and SCB (OR:6.1, P < .001) and had significantly higher percent maximum outcome improvement (63% vs 41%; P= 0.003) and Δ ASES scores (36 vs 12; P < .001). However, patients with preoperative ASES scores above 63 had significantly higher final ASES scores (86 vs 79; P= .003), were more likely to achieve PASS (59% vs 48%; P= .045), and had higher satisfaction scores (7.4 vs 6.7; P= .024). Patients with high preoperative ASES scores achieve less relative improvement; however,these patients may be more likely to achieve PASS and may have higher satisfaction scores postoperatively. LEVELOF EVIDENCE: Level III, retrospective comparative prognostic trial.

Adjacent Joint Arthritis Incidence Rate Following Fusion of the First Tarsometatarsal Joint as Treatment for a Forefoot Deformity

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Nontraumatic forefoot deformities such as hallux valgus (HV) are common causes for patients seeking reconstructive surgery. Known as a “bunion,” HV is characterized by 1-2 intermetatarsal angle widening and first metatarsal head medial drift, resulting in the great toe pointing laterally. Surgery is indicated for patients who fail to find relief with conservative management. However, there is no consensus among orthopedic surgeons on whether osteotomy or first tarsometatarsal (TMT) arthrodesis is the better surgical treatment method. Additionally, no known studies have explored the development of adjacent joint arthritis in patients who have received a first TMT fusion. This study aims to investigate the rate of arthritis development in the adjacent joints following arthrodesis of the first TMT joint. Methods: A retrospective chart review at a tertiary foot and ankle clinic was performed on subjects who received a first TMT fusion between January 2004 and December 2017. This included subjects who received concomitant gastrocnemius recession, tendo-achilles lengthening, 1-2 intermetatarsal arthrodesis, 1-2 intercuneiform arthrodesis, hammertoe corrections, and other soft tissue releases deemed by the senior authors to be inconsequential in the case of adjacent joint arthritis development. Pre- operative, operative, and post-operative indications will be evaluated throughout this thorough chart review, and charts will be continually reviewed for inclusion and exclusion criteria. Patient information gathered includes age, sex, height, weight, BMI, activity level, smoking history, medications, time spent with hardware retained, the method of arthritis diagnosis (x-ray alone, CT, MRI, bone scan), relevant additional diagnoses, and operative data. Pre- and post-operative pain levels and satisfaction scores will follow the AOFAS Score Criteria. Results: Preliminary Results: 899 subjects (148 males, 751 females) are included in this study. The age range was 67 years (18 - 85), with an average age of 56.6 at surgery. Patient BMI varied from 12.7 to 53.1. Concurrent operative soft tissue procedures: gastrocnemius recession (749), tendo-Achilles lengthening (13), and a combination of the two (1). Concomitant fusions: isolated 1- 2 intermetatarsal arthrodesis (799) and combined with 1-2 intercuneiform arthrodesis (695). Clinical follow-up ranged from three to 186 months, averaging 34 (2 years, ten months). Presently, radiographic assessment has been performed for 154 of the 899 patients included in this study. Of these, 11 had developed adjacent joint arthritis at last radiographic follow-up (7.1%); two with naviculocuneiform arthritis, eight with talonavicular arthritis, and one with both. Conclusion: Based on preliminary data, a successful fusion of the first TMT joint, as treatment of a forefoot deformity such as HV, does not appear to accelerate the development of arthritis in the adjacent joints.