Postsurgical Patient Research Articles

Encountering the Cancer Ghosts in ‘Exploding into Life’

Due to its unique aetiology and pathology, cancer cannot simply be understood in the typical diagnosis-treatment-prognosis trajectory. To a post-surgical patient, living with cancer usually implies living with the fear of its recurrence. Cancer, in other words, is a constant invisible presence that haunts. In this article, I focus on cancer's haunting and propose that we turn away from the narrative timeline to a narrative space, in which a ‘ghostly encounter’ with the unspeakable aspect of the cancer experience is possible. I then use Dorothea Lynch's and Eugene Richards' Exploding into Life (1986), a photo-journal of Lynch's breast cancer experience as an example. I use the text to illustrate how it is within this ‘ghostly space’ that we can direct our attention to the not there that is present in the cancer story. As such, it embodies not only Lynch's story of cancer, but also what is repressed (in the others), and how the repressed can return in different (ghostly) forms. And finally, I show how it is through these encounters with the cancer ghosts that a collective story of cancer can be shared and witnessed.

Clinical benefits and economic impact of post-surgical care provided by pharmacists in a Canadian hospital

Clinical pharmacists improve the quality of patient care by reducing adverse drug events (ADEs), length of stay and mortality. This impact is currently not well described in surgery. The objective was to evaluate clinical and economic outcomes after clinical pharmacist services were added to two general surgical wards in an adult hospital. This was a prospective, observational study. All clinical interventions to resolve drug therapy problems were documented and assessed for severity, value and the probability of preventing an ADE. Cost avoidance was calculated using two methods: by avoiding additional days in hospital (CA$3593/ADE) or additional hospital costs ($7215/ADE). Two clinical pharmacy specialists and the surgical care pharmacist independently categorized the interventions; disagreements were resolved by consensus. The pharmacists made 1097 interventions in 6 months with a 98% acceptance rate by surgical staff. Half of the interventions were rated significant for severity (561, 51.1%) and value (559, 51.0%). One-quarter of the interventions had a 40% or greater probability of preventing an ADE (270, 24.6%). Cost avoidance was estimated to be $0.68-1.36 million or $617-1239 per intervention. Pharmacists avoided an additional 867 days in the hospital for surgical patients. The pharmacist's role in the management of the drug therapy needs of the post-surgical patient has the potential to improve clinical and patient outcomes and avoid healthcare costs. The inclusion of clinical pharmacists in surgical wards may result in $7 in savings for every $1 invested.

Patient-Reported Outcomes After Endonasal Rhinoplasty for the Long Nose

The long nose with an inferiorly rotated tip commonly results from a discrepancy between tip support and the downward forces of long septum, long upper lateral cartilage, and elongated lower lateral cartilage. Although many techniques have been described for surgical correction, very few studies were designed to include patient-reported outcomes. The purpose of this study was to introduce our current management of long nose with drooping tips as well as to present the patient-reported outcomes of our case series of endonasal rhinoplasties. This study prospectively analyzed 121 patients who underwent rhinoplasty for the correction of long nose with drooping tips. Study participants completed both a baseline questionnaire before the rhinoplasty operation and a postsurgical patient questionnaire 12 months following the operation, including the European QOL Questionnaire and Rhinoplasty Outcomes Evaluation Questionnaire. Mean values corresponding to the European QOL Questionnaire visual analog scale score significantly increased after surgery compared with baseline (P < 0.01). Mean values corresponding to self-care (P < 0.01), usual activities (P < 0.05), discomfort (P < 0.01), and anxiety (P < 0.01) showed significant decrease after surgery. A general and significant improvement of the mean Rhinoplasty Outcomes Evaluation Questionnaire scores by rhinoplasty increased from 20.14 ± 7.38 to 82.05 ± 12.8 (P < 0.01). Resection of the caudal portion of upper lateral cartilage may correct aesthetic problems in patients with long nose with a drooping tip in which a reduction in the width and the length of middle third of the nose is required. This study suggested an efficient method for aesthetic correction of long nose with the improved patient-reported outcomes.

Safety of a Novel Parenteral Formulation of Diclofenac after Major Orthopedic or Abdominal/Pelvic Surgery in a Population Including Anticoagulated, Elderly or Renally Insufficient Patients: An Open-Label, Multiday, Repeated Dose Clinical Trial

Decisions to use or avoid nonsteroidal anti-inflammatory drugs (NSAIDs) for postsurgical pain are often influenced by concerns about bleeding and renal adverse effects. The objective of this study was to evaluate the safety of a novel parenteral NSAID, hydroxypropyl-β-cyclodextrin (HPβCD) diclofenac, in a large postsurgical patient population, with particular focus on bleeding and renal effects. This was a large open-label study in adult patients with acute moderate-to-severe pain following major surgery. Patients received ≥2 days of continuous treatment with HPβCD diclofenac, administered as a small-volume bolus injection every 6 hours. Few exclusion criteria were applied in order to reflect surgical patient populations commonly managed in clinical practice. Adverse events (AEs) were recorded throughout the study. The incidences of bleeding- and renal-related AEs were examined in patient subpopulations with known risk factors for NSAID-induced complications: advanced age, pre-existing renal insufficiency, concomitant anticoagulant use, prolonged exposure, elevated dosage, and major surgeries. Of the total 971 patients studied, 38% were ≥65 years old (12% >75 years), 62% received concomitant anticoagulants, and 6% had pre-existing renal insufficiency. HPβCD diclofenac was well tolerated by the patient population. AE rates are presented by risk factor to enable clinicians to better describe renal- or bleeding-related AEs. In addition to its previously demonstrated efficacy, this study provides evidence of HPβCD diclofenac's safety in a large postsurgical population including anticoagulated, elderly or renally insufficient patients. Because study exclusion criteria were minimal, these findings may be broadly generalizable to populations commonly treated in clinical practice.

Necessity of a Good Surgical History: Detection of a Gossypiboma

Any patient with a history of previous surgery is at risk for having a gossypiboma, a retained surgical sponge (RSS). An instrument or sponge left in a patient after surgery is a ubiquitous medical error and continues to be a patient safety and surgical quality issue. The incidence of RSSs, various clinical presentations, imaging characteristics, management of clinical consequences, cost, and legal ramifications are reviewed. The nurse practitioner plays an important role in obtaining a thorough surgical history and should consider an RSS in the differential diagnosis of any postsurgical patient with an unresolved or unusual complaint.

Vigilance of hemodynamic changes immediately after transferring patients is crucial

A decrease in blood pressure is sometimes observed when a postsurgical patient is transferred to another bed after recovering from anesthesia. However, the mechanism behind this hypotension has not been completely elucidated. The purpose of this study was to investigate and compare changes in hemodynamic properties for possible causes of hypotension before and after transfer to another bed of postsurgical patients receiving general anesthesia, combined epidural and general anesthesia, or combined spinal and general anesthesia. We studied 69 patients undergoing elective surgery who were randomized to receive anesthesia by one of the three methods. After surgery, the tracheal tube was removed, and each patient was transferred to another bed. Hemodynamic data recorded immediately before and after transfer of the patient to another bed were compared. After transfer of patients receiving general anesthesia or combined epidural and general anesthesia, systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and cardiac output (CO) decreased; heart rate (HR) and systemic vascular resistance (SVR) did not change. However, after transfer of patients receiving combined spinal and general anesthesia, SAP, DAP, HR, and CO decreased, but SVR did not change. The decrease in blood pressure observed after transfer of a postsurgical patient to another bed after general, combined epidural and general, and combined spinal and general anesthesia was associated with a decrease in CO and no change in SVR, but HR decreased after combined spinal and general anesthesia, whereas it was unchanged after general and combined epidural and general anesthesia. The decrease in blood pressure is assumed to be caused by a decrease in venous return, and several reflexes might participate in this decrease of blood pressure, especially after combined spinal and general anesthesia.

A simplified technique to make an immediate surgical obturator for a maxillectomy patient

Patients with advanced carcinomas of the maxillary sinus are often treated with surgical resection by maxillectomy and face several complications including change and difficulty in speech, deglutition, mastication and esthetics, as well as psychological discomfort following the surgery. Most of difficulties can be overcome, to an extent, with the placement of an immediate surgical obturator. This clinical report describes the fabrication of a removable immediate surgical obturator for a patient with stage 4 carcinoma of the maxilla, which uses the patient's original occlusion and tooth position, made prior to the surgical resection and inserted at the time of surgery, to provide the patient with a means of masticatory efficiency, esthetics and psychological comfort during the healing period.Clinical Relevance to Interdisciplinary DentistryHighlights a team effort in the management of oral and facial carcinomas - Surgeon, Pathologist and Prosthodontist. Provides a stable foundation for fabrication of future prosthesis.Prosthetics to aid in the surgical management of scar tissues.Esthetics and facial form maintained following surgery, minimizing post-surgical patient depression.

Utility of the Short Double-Balloon Enteroscope to Perform Pancreaticobiliary Interventions in Patients with Surgically Altered Anatomy in a US Multicenter Study

Double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreaticography (DBE-ERCP) is an effective method for interventions in the pancreaticobiliary system in the post-surgical patient. However, use of currently available endoscopic accessories during this procedure is limited due of the length of the conventional instrument (200cm). The aim of this study was to explore the utility of the short DBE (152cm) for the management of pancreaticobiliary disorders in patients with surgically altered anatomies. Data were collected retrospectively on patients with various anatomic variations in whom ERCP was performed using the short DBE from April 2008 to November 2011. Basic demographic information, clinical presentation, preoperative imaging, and type of surgery, procedural technical success rate, and adverse events were evaluated. Descriptive analysis was used to document the demographic and clinical data of the patients. We identified 79 patients in whom DBE-ERCP was attempted (38% male, mean age 58years). Indications for the procedure were removal of a previously placed stent (n=5), suspected sphincter of Oddi dysfunction type 1 (n=3), surgical biliary leak (n=3), pancreatic anastomotic stricture (n=2), suspected biliary stones (n=48), and biliary strictures visualized on imaging (n=18). Overall, the success rate of DBE-ERCP in all patients was 81% (64/79). The scope could not reach the papilla or surgical anastomosis in 8 cases and duct cannulation failed in 7 cases. The following interventions were performed: biliary sphincterotomy (n=39), dilation of CBD stenosis with a balloon (n=30), biliary stent insertion (n=25), stone removal (n=35), brushing cytology of biliary strictures (n=3), and stent retrieval (n=4). Three patients developed post-procedure pancreatitis. There was 1 episode of self-limited bleeding. The current study demonstrates that DBE assisted ERCP for pancreaticobiliary interventions using a short enteroscope are feasible in patients with surgically altered anatomy.

783 Tracheostomy as an Independent Predictor of Sternal Wound Infection

In the post cardiac surgical patient, the traditionally held belief that soiling of the surgical site from a tracheal stoma increases the risk of sternal wound infection (SWI) continues to influence clinical decision-making regarding this intervention. The purpose of this study was to investigate whether tracheostomy was associated with SWI post cardiac surgery. Following institutional REB approval, all patients undergoing cardiac surgery via median sternotomy from September 1, 1997 to October 31, 2010 were included in this retrospective observational study. Patients with preoperative tracheostomy in situ and those patients receiving tracheostomy following documented SWI were excluded. Primary exposure was tracheostomy performed during ICU admission. Primary outcome was SWI. Secondary outcomes were in-hospital mortality and ICU length of stay. Perioperative patient characteristics and outcomes were compared using t-tests and chi-square tests. Variables found to be strongly associated with SWI (p<0.1) were entered into a multivariable stepwise logistic regression model, for the determination of predictors of SWI. Also included the model were variables that were repeated reported to predict SWI in literature. 411 of 18845 included patients had tracheostomy prior to SWI with a median time to tracheostomy of 14 days. The incidences of SWI in the tracheostomy and non-tracheostomy groups were 19.53%(80/411) and 0.84%(154/18434), respectively. On univariate analysis, SWI was associated with age, female gender, higher preoperative risk scores, diabetes, poor LV function, harvest of internal thoracic arteries, resternotomy, cardiopulmonary bypass time, renal replacement therapy, cardiogenic shock, reopen postoperatively, reintubation and mechanical ventilation >72 hours. Tracheostomy was associated with SWI (p<0.0001) and increased mortality (30.4%[125/411] vs. 2.6%[472/18434]; p<0.0001) and ICU length of stay (44±32.3 days vs. 2.4±3.8 days; p<0.0001). On multivariable analysis, tracheostomy was found to be an independent predictor of SWI (OR 2.38). The 1.2% (234/18845) incidence of SWI in our cohort is in keeping with previously reported rates of SWI following cardiac surgery ranging between 0.4 to 8.6%1Ann Thorac Surg. 2005 Aug; 80: 618-621PubMed Google Scholar, 2Intensive Care Med. 2008 Oct; 34: 1779-1787Crossref PubMed Scopus (177) Google Scholar, 3Ann Thorac Surg. 2007 Dec; 84: 1984-1991Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar, 4J Thorac Cardiovasc Surg. 1996; 111: 1200-1207Abstract Full Text Full Text PDF PubMed Scopus (267) Google Scholar. However, the relationship between tracheostomy and SWI has been variably reported and remains uncertain1Ann Thorac Surg. 2005 Aug; 80: 618-621PubMed Google Scholar, 2Intensive Care Med. 2008 Oct; 34: 1779-1787Crossref PubMed Scopus (177) Google Scholar, 3Ann Thorac Surg. 2007 Dec; 84: 1984-1991Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar, 4J Thorac Cardiovasc Surg. 1996; 111: 1200-1207Abstract Full Text Full Text PDF PubMed Scopus (267) Google Scholar. Rahmanian's multivariable analysis concluded respiratory failure, rather than tracheostomy, was predictive of SWI3Ann Thorac Surg. 2007 Dec; 84: 1984-1991Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar. Our multivariable model found tracheostomy to be a strong and independent predictor of SWI (OR=2.38), after adjusting for the same surrogates for respiratory failure used in Rahmanian's paper.

Including aortic valve morphology in computational fluid dynamics simulations: Initial findings and application to aortic coarctation

Computational fluid dynamics (CFD) simulations quantifying thoracic aortic flow patterns have not included disturbances from the aortic valve (AoV). 80% of patients with aortic coarctation (CoA) have a bicuspid aortic valve (BAV) which may cause adverse flow patterns contributing to morbidity. Our objectives were to develop a method to account for the AoV in CFD simulations, and quantify its impact on local hemodynamics. The method developed facilitates segmentation of the AoV, spatiotemporal interpolation of segments, and anatomic positioning of segments at the CFD model inlet. The AoV was included in CFD model examples of a normal (tricuspid AoV) and a post-surgical CoA patient (BAV). Velocity, turbulent kinetic energy (TKE), time-averaged wall shear stress (TAWSS), and oscillatory shear index (OSI) results were compared to equivalent simulations using a plug inlet profile. The plug inlet greatly underestimated TKE for both examples. TAWSS differences extended throughout the thoracic aorta for the CoA BAV, but were limited to the arch for the normal example. OSI differences existed mainly in the ascending aorta for both cases. The impact of AoV can now be included with CFD simulations to identify regions of deleterious hemodynamics thereby advancing simulations of the thoracic aorta one step closer to reality.

Use of recombinant activated Factor VII for refractory after lung transplant bleeding as an effective strategy to restrict blood transfusion and associated complications

Recombinant activated factor VIIa (rFVIIa) has been increasingly used to stop massive bleeding after cardiothoracic surgical procedures. However, the risk : benefit profile of such a potent hemostatic agent remains unclear in the postsurgical patient, and the cost benefit is even less clear. In patients after lung transplantation, volume of blood transfused is of major concern, and all attempts are made to minimize large blood transfusions in this cohort. We report our experience with rFVIIa in patients with refractory bleeding after lung transplant surgery. All lung transplant patients who underwent single- or double-lung transplantation who received rFVIIa in the 5-year period, from January 2005 to June 2011, were included. A total of 15 patients were identified from a total of 95 lung transplant cases operated during this study period. Patient demographics, intra- and postoperative records were reviewed to assess the efficacy and safety of rFVIIa treatment. Patients with major bleeding treated with rFVIIa showed improved hemostasis with rapid normalization of coagulation variables. rFVIIa treatment was not associated with an increase in mechanical ventilation time, length of intensive care unit stay, or hospital stay compared to other lung transplant patients. In addition, the use of rFVIIa was associated with reduction in transfusion requirements of red blood cells, fresh-frozen plasma, and platelets (all p < 0.001). No definite thromboembolic-related event was recorded in our cohort. These data demonstrate that rFVIIa was associated with reduced blood loss, improvement of coagulation variables, and decreased need for transfusions. This reduction in losses led to a reduced requirement for blood transfusion, which may translate to a decrease in transfusion-related complications. Further investigation is needed to determine rFVIIa's safety and its efficacy in improving postoperative morbidity and mortality specifically in the field of post-lung transplantation surgery.

Use of a proliferation-based mRNA signature to predict outcome in early-stage non-small cell lung adenocarcinoma.

7023 Background: Adjuvant treatment of patients with early-stage lung adenocarcinoma is based on post-surgical pathological staging and patient performance status. Disparate outcomes within each staging group suggest that additional prognostic markers could improve our understanding of risk-benefit and potentially lead to better treatment decisions. A proliferation-based, mRNA expression profile was applied to public microarray data of surgically treated lung adenocarcinomas and a cohort of FFPE samples to test its potential prognostic utility. Methods: Public expression data (Director’s Consortium, DC) were derived from Affymetrix HG-U133A arrays. Clinical FFPE samples were assayed by quantitative PCR. A cell cycle progression (CCP) score was calculated from the expression average of 31 cell cycle genes normalized by 15 housekeeper genes. The prognostic value of the CCP score to predict stage I and II patient outcomes was evaluated by Cox proportional hazards analysis with disease-related death as the primary outcome measure. Results: In 256 DC cases, the CCP score was a significant predictor of death in univariate (p=0.0001) and multivariate analysis (p=0.001, HR 1.57, 95%CI 1.20-2.05) using age, stage, gender, smoking status and treatment as covariates. Similarly, in a second data set (GSE31210, n=204) the CCP score was highly associated with death (univariate, p=0.001; multivariate analysis, p=0.003, HR 1.81, 95% CI 1.24-2.66). Using quantitative PCR, the signature was applied to 381 FFPE samples with a median follow-up of 5 years collected at the MD Anderson Cancer Center and the European Institute for Oncology. In the presence of clinical covariates (as above and tumor size and pleural invasion), the CCP score remained the most significant predictor of death in univariate (p=0.0003) and multivariate analysis (p=0.007, HR 1.50, 95% CI 1.11-2.02). Conclusions: A 46 gene mRNA signature is a significant predictor of disease-related death in early-stage lung adenocarcinoma, providing independent prognostic value in the presence of clinical variables. This molecular predictor of cancer survival will be studied in additional cohorts for its ability to impact clinical treatment decisions.

An evaluation of the predictive validity of different pain intensity measures in a prospective, longitudinal, observational study of a post-surgical patient cohort

The Brief Pain Inventory (BPI) assesses pain intensity on a variety of dimensions including: average, worst, and least pain intensity in the last 24 hours, and pain intensity at the present moment. Each of these may have individual advantages but likely engage different evaluative and cognitive processes in any individual's response. Thus the underlying processes that are being measured may be related to the specific construct one is attempting to measure. To evaluate the predictive validity of these measures we conducted a secondary analysis of a prospective, longitudinal observational study among 109 surgical patients.

The Prevention of Chronic Postsurgical Pain Using Gabapentin and Pregabalin

Many clinical trials have demonstrated the effectiveness of gabapentin and pregabalin administration in the perioperative period as an adjunct to reduce acute postoperative pain. However, very few clinical trials have examined the use of gabapentin and pregabalin for the prevention of chronic postsurgical pain (CPSP). We (1) systematically reviewed the published literature pertaining to the prevention of CPSP (≥ 2 months after surgery) after perioperative administration of gabapentin and pregabalin and (2) performed a meta-analysis using studies that report sufficient data. A search of electronic databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, IPA, and CINAHL) for relevant English-language trials to June 2011 was conducted. The following inclusion criteria for identified clinical trials were used for entry into the present systematic review: randomization; double-blind assessments of pain and analgesic use; report of pain using a reliable and valid measure; report of analgesic consumption; and an absence of design flaws, methodological problems or confounders that render interpretation of the results ambiguous. Trials that did not fit the definition of preventive analgesia and did not assess chronic pain at 2 or more months after surgery were excluded. The database search yielded 474 citations. Eleven studies met the inclusion criteria. Of the 11 trials, 8 studied gabapentin, 4 of which (i.e., 50%) found that perioperative administration of gabapentin decreased the incidence of chronic pain more than 2 months after surgery. The 3 trials that used pregabalin demonstrated a significant reduction in the incidence of CPSP, and 2 of the 3 trials also found an improvement in postsurgical patient function. Eight studies were included in a meta-analysis, 6 of the gabapentin trials demonstrated a moderate-to-large reduction in the development of CPSP (pooled odds ratio [OR] 0.52; 95% confidence interval [CI], 0.27 to 0.98; P = 0.04), and the 2 pregabalin trials found a very large reduction in the development of CPSP (pooled OR 0.09; 95% CI, 0.02 to 0.79; P = 0.007). The present review supports the view that perioperative administration of gabapentin and pregabalin are effective in reducing the incidence of CPSP. Better-designed and appropriately powered clinical trials are needed to confirm these early findings.

Effects of Hospital Nurse Staffing on in-hospital Mortality, Pneumonia, Sepsis, and Urinary Tract Infection in Surgical Patients

This study was done to examine relationships between nurse staffing level and postsurgical patient outcomes using inpatient database from the National Health Insurance. Records of 111,491 patients who received one of 12 types of surgery between January and December, 2009 were identified and analyzed in this study. Nurse staffing level was measured using adjusted nurse staffing grades from 0 to 7. Patient outcomes were defined as in-hospital mortality, or pneumonia, sepsis, or urinary tract infection after surgery. Logistic regression analyses estimated by Generalized Estimation Model, were used to analyze the association between nurse staffing level and patient outcomes. An inverse relationship was found between nurse staffing and patient mortality. Compared with patients who were cared for in hospitals with the highest nurse staffing (Grades 0-1), increases in the odds of dying were found in those with Grades 6-7 [OR (odds ratio)=2.99, 95% CI (confidence interval)=1.94-4.60], those with Grades 4-5 (OR=1.78, 95% CI=1.24-2.57) and those with Grades 2-3 (OR=1.57, 95% CI=1.25-1.98). Lower nurse staffing level was also associated with higher number of cases in pneumonia and sepsis. Policies for providing adequate nurse staffing is required to enhance quality of care and lead to better perioperative patient outcomes.

Current Concepts in Clinical Research: Web-Based, Automated, Arthroscopic Surgery Prospective Database Registry

In 2011, postsurgical patient outcome data may be compiled in a research registry, allowing comparative-effectiveness research and cost-effectiveness analysis by use of Health Insurance Portability and Accountability Act-compliant, institutional review board-approved, Food and Drug Administration-approved, remote, Web-based data collection systems. Computerized automation minimizes cost and minimizes surgeon time demand. A research registry can be a powerful tool to observe and understand variations in treatment and outcomes, to examine factors that influence prognosis and quality of life, to describe care patterns, to assess effectiveness, to monitor safety, and to change provider practice through feedback of data. Registry of validated, prospective outcome data is required for arthroscopic and related researchers and the public to advocate with governments and health payers. The goal is to develop evidence-based data to determine the best methods for treating patients.

The Surgical Satisfaction Questionnaire (SSQ-8): A Validated Tool for Assessment of Patient Satisfaction Following Surgery To Correct Prolapse and/or Incontinence

To develop a validated questionnaire to assess patient satisfaction following surgery to correct urinary incontinence and/or pelvic organ prolapse. Existing surgical satisfaction surveys focus on the physician or facility rather than the surgical outcome itself. Many times patient satisfaction does not correlate with objective surgical outcomes, or even subjective symptom reporting. There are currently no surgical satisfaction assessment tools designed for any type of surgery, specifically pelvic reconstructive surgery. The process and results of validating a post surgical patient satisfaction questionnaire. A private urogynecology practice in Pennsylvania. 400 women underwent surgery to correct stress urinary incontinence and/or pelvic organ prolapse, each completed the SSQ-8 at 4 months and 1 year. A separate group of 157 women completed the SSQ-8 and an office based satisfaction survey developed by Press Ganey. The lead author developed 12 questions that seemed directly relevant to surgical satisfaction. Face validity was further established by a group of 8 Urogynecologists and 4 Urogynecology nurses who honed it to 8 likert scale questions deemed relevant and non-redundant. Test-retest reliability was assessed by administering the survey to patients at 4 months and 1 year post-op. External validity was assessed by administering a well-established Press Ganey survey designed for medical practices to patients that had also completed the SSQ-8. The questionnaire's test-retest reliability was .80 p<.0001, assuring predictability between the 2 test intervals. The internal consistency reliability, based on Cronbach's alpha was .79. The Bonferroni-adjusted p-value < .02 denoted statistical significance due to the multiple comparisons. The association between SSQ-8 and medical practice survey summary scores revealed a moderate and statistically significant positive correlation (r=.28, p=.004). This questionnaire (SSQ-8) is a valid and reliable tool to measure patient satisfaction after pelvic surgery.

Abstract C5: Surface profiles of colorectal cancer cells and inflammatory lymphocytes correlate with blood neutrophil/lymphocyte ratios

Abstract Background: Half of the patients diagnosed with colorectal cancer (CRC) relapse and succumb to systemic disease within 5 years. In most hospitals, multidisciplinary postoperative care focuses on identifying histo- and clinicopathological tumour characteristics. Adjuvant therapy based on these standardized staging systems has resulted in mixed success; as few as 10–20% of patients may benefit. The clinical course for individual patients remains unpredictable, with prognostic heterogeneity for patients with same-stage tumours. Single biomarkers have limited utility; patterns or profiles of biomarkers will be required to predict post-surgical disease progression and patient prognosis. Local inflammation may have a negative or positive effect upon cancer development; for example, neutrophils may mediate tumor angiogenesis. A high neutrophil to lymphocyte ratio (NLR) in the peripheral blood has been associated with poorer patient survival and response to chemotherapy (Chua et al., 2011). We have developed a new system for sub-classification of CRC based upon extensive surface profiles and these results have been correlated with the NLR. Methods: The DotScan CRC antibody microarray captures live cells on immobilized antibodies against 122 surface CD antigens. Fresh surgical CRC samples (69) with corresponding normal intestinal mucosa were disaggregated to produce viable single cell suspensions that were captured on microarrays. Binding dot patterns were recorded for subsets of cells labeled with fluorescent antibodies. Epithelial cell adhesion molecule (EpCAM) labeled CRC cells; CD3 labeled tumour-infiltrating T-lymphocytes (TILs). Differential white blood cell counts and NLRs were obtained for each patient from hematology reports. Results: Statistical analysis showed significant immunophenotypic differences between CRC and control mucosal cell populations. Unsupervised hierarchical clustering of these data identified several patient sub-groups based on EpCAM (CRC cells) and CD3 (TILs) profiles. Differentially expressed CD antigens were recognized between groups of patients with low, medium or high NLRs. The DotScan CRC microarray may provide disease signatures for distinguishing patients with good and poor prognosis, and an alternative to current pathology CRC staging systems. Chua W, Charles KA, Baracos VE, Clarke SJ (2011) Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Br J Cancer 104:1288–1295. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the Second AACR International Conference on Frontiers in Basic Cancer Research; 2011 Sep 14-18; San Francisco, CA. Philadelphia (PA): AACR; Cancer Res 2011;71(18 Suppl):Abstract nr C5.

Outcomes Research in Rhinoplasty: Body Image and Quality of Life

Although hundreds of quality-of-life (QOL) studies are available in the literature, very few were designed that include both a global and a procedure-specific evaluation of QOL and an inventory for the assessment of body image. The purpose of this study was to use condition-specific and global measures as well as psychological evaluations in a case series of rhinoplasties for a more comprehensive assessment of patient-reported outcomes. Records of 225 patients aged 18-57 years who underwent rhinoplasty were prospectively included in the study. Study participants completed both a baseline questionnaire before the rhinoplasty operation and a postsurgical patient questionnaire 12 months after the operation, including the European QOL Questionnaire (EQ), Rhinoplasty Outcomes Evaluation Questionnaire (ROE), and the Multidimensional Body-Self Relations Questionnaire (MBSRQ). Mean values corresponding to the EQ VAS results except for discomfort and anxiety domains increased after treatment compared with baseline. Both male and female patients experienced significant improvement in ROE scores, with larger differences between pre- and postoperative ROE scores in male patients compared with female patients. The analyses of variance in the MBSRQ results revealed significant postsurgical improvements on the appearance orientation subscale. The development, standardization, and use of validated procedure-specific QOL tools are essential components for accurately measuring patient-reported outcomes of facial plastic surgery procedures. To measure patient satisfaction in a more objective and standardized manner, specific questionnaires or instruments should be used that can determine the QOL changes associated with each procedure of interest.

Difficulties of Delayed Treatment of Craniosynostosis in a Patient With Crouzon, Increased Intracranial Pressure, and Papilledema

Crouzon syndrome is an autosomal dominant disorder characterized by cranial synostosis, hypertelorism, orbital proptosis, parrot-beaked nose, short upper lip, hypoplastic maxilla, and a relative mandibular prognathism, without extremity involvement. Surgical intervention should occur at the onset of progressive craniosynostosis to treat or to prevent intracranial hypertension and visual impairment. Throughout developing countries, early treatment is often not a viable option. Often, the only option for treatment is through humanitarian missions. Appropriate preselection of surgical patients is essential, as is having a multidisciplinary team and a well-equipped hospital and staff to perform the operations and to care for the postsurgical patient. This type of humanitarian care benefits the patient selected to receive the intense logistical and financial effort when there is no possibility of timely care in their own countries. This clinical report describes a patient with Crouzon syndrome brought to the United States from a developing country through humanitarian efforts. She presented at 19 months of age with bicoronal and sagittal synostosis and advanced visual impairment and papilledema. Surgical intervention included cranial expansion and reconstruction with a multidisciplinary team. This case illustrates not only the difficulty of delayed treatment but also some of the issues arising from this type of humanitarian medical care.