Preoperative Patient Care Research Articles

Key Considerations for Frail Patients Undergoing Hip Fracture Surgery.

Improving preoperative care for elderly patients with hip fractures is crucial for achieving the best outcomes. A multidisciplinary team that can improve overall care quality by addressing patient's medical conditions, analgesia, timely surgery, and early postoperative mobilization is required. This narrative review provides insights regarding the extent of preoperative optimization needed for hip fracture surgery.

Barriers and facilitators of the nurse providing evidence-based preoperative visit-care for transcatheter aortic valve replacement: a mixed-methods study based on an evidence application setting

BackgroundPreoperative visit-care for transcatheter aortic valve replacement (TAVR) plays a crucial role in improving the quality of care and patient safety. However, preoperative care for TAVR patients is still in its early stages in China, with the care often being experience-based. The application of relevant evidence in nursing practice is necessary. Little is known regarding the facilitators and barriers to apply and compliance to the evidences about preoperative visit-care for TAVR in nursing.MethodsThe Nurse’s Compliance Checklist was used to investigate the evidence-based compliance of nurses (n = 21) who worked in the TAVR team in the evidence-based implementation setting. Meanwhile, an Evidence-Based Practice Beliefs Scale, and Influencing Factors Checklist were used to investigate all nurses (n = 66) who work in the same setting. Stakeholders (Middle and senior-level nursing administrators, frontline clinical nurses, and patients) interview was carried out to further disclose the barriers and facilitators in the process of evidence-based practice.ResultsThe results of this study showed that only 1 evidence implemented fully (100%) by nurses, 3 evidences with 0% implementation rate, and implementation rate of the other evidences were 9.5∼71.4%. The overall score of nurses’ evidence-based nursing belief level was (3.52 ± 0.82). Three domains of barriers were identified: the Context Domain included lack of nursing procedures, inadequate health education materials, insufficient training; the Practitioner Domain included insufficient attention, lack of relevant knowledge, high work pressure and uncertainty of expected results, and Patient Domain included lack of relational knowledge. Facilitating factors included leadership support, nurse’ high evidence-based nursing belief, high executive ability and enthusiasm for learning.ConclusionThe study indicated that the nurses’ compliance of evidence-based practice in preoperative visit-care for TAVR was in lower level. There were some factors influencing the application of the evidences. The study revealed potential modifiable barriers to the successful implementation of evidence-based preoperative visit-care, including a lack of preoperative visit- care routine, related knowledge and training. Leadership support and nurse training should be considered to improve nurses’ compliance with evidence-based practice.

ThP7.16 - Multidisciplinary management of elderly patients undergoing emergency laparotomy: an audit at a small district general hospital

Abstract Aims The National Emergency Laparotomy Audit (NELA) suggests early involvement of the multidisciplinary geriatrician team for preoperative care of elderly patients aged over 80, or 65 and frail. Methods we audited our unit against the NELA guidelines for elderly patients. We looked at all emergency laparotomies carried out at our hospital over a 6 month period against the audit standards as set out by NELA. Results A total of 55 laparotomies were carried out in 6 months. 17 patients fit the criteria of patients needing early geriatrician involvement. Of the 34 patients aged 65 and above, 22 patients had their frailty score recorded in the notes (64%). Less than 10% of patients had early geriatrician input. Overall, six patients (11%) died within 30 days of their initial operation, and all were aged over 65. Conclusions we must take the perioperative care of elderly patients seriously and work with the Geriatric Medicine teams for early perioperative review, including accurate clinical frailty score assessments. We will initiate a project with the Geriatric Medicine department to implement an Elderly Laparotomy Perioperative Pathway for these patients.

Knowledge and Practices of Nurses on Preoperative Fasting Guidelines Care for Adult Patients: A Review

Preoperative fasting is the term used to describe the time before a surgical procedure during which patients are not permitted to consume any liquids or solids by mouth. Pre-operative fasting guidelines for adult patients are critical for ensuring the well-being and safety of surgical patients. Pre-operative fasting is a standard practice designed to reduce the risk of complications during surgery, such as gastric aspiration. Fasting helps to prevent complications like pulmonary aspiration pneumonia, which can occur if patients do not empty their stomachs before surgery. Fasting durations for solids, liquids, and clear fluids are typically recommended in guidelines. Fasting before surgery or medical procedures that require anesthesia is a common practice. Fasting is done to reduce the risk of aspiration, which occurs when stomach contents enter the lungs during anesthesia and can lead to serious complications. The general guidelines for preoperative fasting typically include avoiding solid food for a specific period before the procedure, as well as limiting liquid intake. Fasting durations and recommendations, on the other hand, can vary. There has been some evolution in preoperative fasting guidelines in recent years. The traditional method involved fasting for extended periods, sometimes up to 12 hours or more for solid food and 2-6 hours for clear liquids. Recent research and updated guidelines in various countries suggest that shorter fasting periods may be just as effective in preventing aspiration while also improving hydration and reducing the stress associated with prolonged fasting. Many healthcare facilities are now more relaxed about preoperative fasting, allowing clear liquids up to 2 hours before surgery and light meals up to 6 hours before the procedure. It is important to note, however, that these guidelines are subject to change, specific fasting instructions are dependent on factors such as the type of surgery, the patient's health status, and .....

Does the patient's physical activity affect the course of cardiac surgery - a comprehensive approach to cardiac surgery patients

Cardiovascular diseases represent a leading cause of morbidity worldwide. Over the past years, the field of cardiac surgery has significantly evolved. Globally, more than 2 million cardiac surgeries are performed annually. Among the main procedures are coronary artery bypass grafting (CABG), valve replacements, and heart transplants. The increasing number of patients requiring such treatment and, consequently, the rising number of procedures performed imply an improvement in their quality. With advancements in surgical techniques, the scope of patients eligible for procedures has also expanded. Patients undergoing cardiac surgeries are increasingly older and often suffer from significant comorbidities, such as hypertension and diabetes. Effective cardiac surgery significantly enhances the quality of life. When caring for a patient undergoing cardiac surgery, many aspects of the patient need to be considered to approach them holistically, while simultaneously creating an individualized treatment pathway. Not only the cardiac aspect but also various other factors need to be taken into account, including the patient's diet, medications, comorbidities, mental state, and physical activity. In this work, we emphasize the role of both postoperative and preoperative care for cardiac surgery patients, which, when properly executed, can be the key to the patient's recovery.

A retrospective analysis of the management and surgical treatment of orbital lesions: Outcomes and rationale

The orbital cavity is a subject of interest for various specialists, and achieving optimal outcomes requires comprehensive, multidisciplinary management. This study aims to report 10 years of experience in the preoperative, surgical, and postoperative care of patients with orbital lesions, examining their clinical, radiological, and anatomopathological features and outcomes.A retrospective review of 125 patients who underwent surgical treatment for intraorbital masses between January 2012 and December 2021 was performed. Outcome measures included postoperative diplopia, exophthalmos, decimal visual acuity, eyeball position, ocular motility, operative time, complications, and aesthetic results. A total of 107 patients were included. All cases were discussed with a neuroradiologist to determine the best therapeutic approach based on preoperative imaging.Preoperative diplopia was linked to extraconal (p = 0.03) and anterior (p = 0.001) lesions, and exophthalmos and visual acuity deterioration were associated with intraconal (p = 0.02; p = 0.03) and retrobulbar (p = 0.001; p = 0.02) lesions. Complications (11.2%) included diplopia, worsened visual acuity, postoperative blepharoptosis, and postoperative ectropion. Of the patients, 80.4% reported an "excellent" aesthetic outcome.This study underscores the importance of a multidisciplinary approach based on a thorough analysis of preoperative imaging. Periorbital approaches tailored to the lesion's three-dimensional location enables safe access to most intraorbital lesions, resulting in minimal complications and good aesthetic results.

Is there an impact of a video-based patient informed consent in elective hand surgery?

BackgroundPatient informed consent is a crucial subject in preoperative care of patients before elective hand surgery, ensuring that patients have the necessary information and a comprehensive understanding to make autonomous decisions. The use of video-based informed consent systems is an innovative concept to enhance the consent process with multimedia tools. In addition to the conventional process, mostly relying on verbal communication and written documents, the video-based approach aims to present information in a standardized and visually appealing format.MethodsIn this study, 33 patients were asked to watch a video on a tablet about the planned elective hand surgery after a conventional pre-treatment consultation including informed consent throughout verbal explanations and paper forms by an attending physician or resident. All patients were asked to complete a questionnaire after watching the video.ResultsAn overwhelming majority of participants, specifically 97.0%, stated that the video improved their understanding of the upcoming surgery. 90.9% of the participant would refer the video to other patients undergoing elective hand surgery, while 72.7% of participants indicated that they would have appreciated the opportunity to view an informational video before undergoing different types of surgeries in the past.ConclusionThe use of a video-based patient information system in elective hand surgery had a positive impact on patient education and satisfaction with the informed consent process. Therefore, it is a powerful tool in preoperative management to guarantee a standardized and educative informed consent.

Preoperative Hepatology and Primary Care Visits Improve Postoperative Outcomes in Patients With Cirrhosis Undergoing Surgery

Background and aimsCirrhosis patients are at increased risk for postoperative complications. It remains unclear whether preoperative nonsurgical clinician visits improve postoperative outcomes. We assessed the impact of preoperative primary care physician (PCP) and/or Gastroenterologist/Hepatologist (GI/Hep) visits on postoperative mortality in cirrhosis patients undergoing surgery and explored differences in medication changes and paracentesis rates as potential mediators. MethodsThis was a retrospective cohort study of cirrhosis patients in the Veterans Health Administration who underwent surgery between 2008 and 2016. We compared 1982 patients with preoperative PCP and/or GI/Hep visits with 1846 propensity matched patients without preoperative visits. We used Cox regression and Fine and Gray competing risk regression to evaluate the association between preoperative visit type and postoperative mortality at 6 months. ResultsPatients with preoperative GI/Hep and PCP visits had a 45% lower hazard of postoperative mortality compared to those without preoperative visits (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.35-0.87). A smaller effect size was noted with GI/Hep preoperative visit alone (HR, 0.69; 95% CI, 0.48-0.99) or PCP visit alone (HR, 0.70; 95% CI, 0.53-0.93). Patients with preoperative PCP/GI/Hep visits were more likely to have diuretics, spontaneous bacterial peritonitis prophylaxis, and hepatic encephalopathy medications newly initiated and/or dose adjusted and more likely to receive preoperative paracentesis as compared to those without preoperative visits. ConclusionPreoperative PCP/GI/Hep visits are associated with a reduced risk of postoperative mortality with the greatest risk reduction observed in those with both PCP and GI/Hep visits. This synergistic effect highlights the importance of a multidisciplinary approach in the preoperative care of cirrhosis patients.

New Approaches to Overcoming Antimicrobial Resistance in Endophthalmitis.

Endophthalmitis is a rare but vision-threatening infection characterized by marked inflammation of intraocular fluids and tissues, uncommonly seen following surgery and intravitreal injection. Antimicrobials are used worldwide in the prophylaxis and treatment of bacterial and fungal infections of the eye and are standard treatment in the preoperative and postoperative care of surgical patients. However, antimicrobials are reported to be overprescribed in many parts of the world, which contributes to antimicrobial resistance (AMR). AMR complicates the prophylaxis and treatment of endophthalmitis. This article examines the prevalence and mechanisms of AMR in ocular microorganisms, emphasizing the importance of understanding AMR patterns for tailored treatments. It also explores prophylaxis and management strategies for endophthalmitis, with a discussion on the use of intracameral antibiotic administration. The use of prophylactic intracameral antibiotics during cataract surgery is common in many parts of the world but is still controversial in some locations, especially in the US. Finally, it highlights the role of stewardship in ophthalmology and its benefits in the treatment of endophthalmitis.

Does preoperative calcium and 1, 25 OH vitamin D supplementation impact postoperative hypocalcemia and length of stay following pediatric thyroidectomy?

ObjectiveTo investigate whether perioperative calcium and 1,25 OH vitamin D supplementation (PCDS) influences the rates of postoperative hypocalcemia and length of stay (LOS) following pediatric thyroidectomy. Study designRetrospective Cohort Review. SettingTertiary children's hospital. Methods94 patients who underwent completion or total thyroidectomy with or without concomitant neck dissection from 2010 to 2020 at a single institution were included. Patients with pre-existing hypocalcemia or preoperative vitamin D insufficiency were excluded. Rates of postoperative hypocalcemia and LOS were compared for patients receiving PCDS to those receiving no supplementation. ResultsThirty percent of patients with PCDS had documented postoperative hypocalcemia compared to 64% of patients without PCDS (p = 0.01). Patients with PCDS had a median LOS of 30 h compared to 36 h (p = 0.002). Multivariable analyses confirmed that patients with PCDS had lower odds of postoperative hypocalcemia (OR: 0.32, CI: 0.11, 0.89) and shorter LOS by 17 h (SE: 8, p = 0.04) after adjustment for confounders. ConclusionPCDS is associated with significantly lower risk of hypocalcemia and shorter LOS. Standardizing preoperative care for pediatric patients undergoing thyroidectomy may decrease variability and improve outcomes following surgery.

Lavender aromatherapy: Its effect on preoperative anxiety and propofol requirement for anesthesia

Background & objective: Preoperative anxiety is a natural human psychology, and the physicians usually prescribe tranquillizers to allay the anxiety of their anxiety. Various other means have also been employed for this purpose. We aimed to investigate the impact of lavender aromatherapy on preoperative anxiety and propofol requirement at induction of anesthesia.
 Methodology: A total of 108 female patients were enrolled in the study, and their anxiety levels were evaluated using the Visual Analogue Scale (VAS) at three different time points. Patients were randomly divided into two groups. Group A (Lavender Group) patients were given lavender aromatherapy via a cotton strip infused with two drops of 100% pure lavender essential oil, while the patients in Group B (Control Group) had no aromatherapy.
 Results: The results showed that the lavender aromatherapy significantly reduced anxiety in Group A (P < 0.001) compared to Group B, and the mean differences of VAS scores for all anxiety assessments were also significantly reduced in Group A (P < 0.000). In addition, the mean total amount of propofol required was significantly less in Group A than in Group B (118.46 ± 40.01 vs 140.38 ± 35.29 mg; P = 0.003), while the mean duration to reach loss of consciousness was similar in both groups.
 Conclusion: The findings of our study suggest that lavender aromatherapy can be a simple, safe, and cost-effective way to reduce preoperative anxiety and decrease the amount of propofol required for the induction of anesthesia. Therefore, the use of lavender aromatherapy may be a valuable addition to the preoperative care of patients undergoing elective surgeries.
 Abbreviations: APAIS- Amsterdam Preoperative and Information Scale; LOC- Loss of Consciousness; OT- Operation Theatre; OR- Operating Room; STAI- State-Trait Anxiety Inventory; VAS- Visual Analogue Scale
 Key words: Aromatherapy; Benzodiazepines; Lavender; Anxiety, Preoperative; Propofol; Anxiety / therapy; Anxiety Disorders
 Citation: Rahman RA, Vasu Dewan MM, Sayed Masri SNN, Mokhtar MN, Abdullah FH, Md Nor N. Lavender aromatherapy: Its effect on preoperative anxiety and propofol requirement for anesthesia. Anaesth. pain intensive care 2024;28(1):20−25; DOI: 10.35975/apic.v28i1.2376
 Received: April 26, 2023; Reviewed: November 22, 2023; Accepted: November 22, 2023

Hubungan Usia dengan Tingkat Kecamasan pada Pasien Bedah Elektif Dewasa

Background: Every patient has different views and reactions to surgery,one of which is experiencing anxiety. Anxiety can be influenced by several characteristics, including age, gender, education, work situation, and marital status. The purpose of this study was to determine whether there is a relationship between patient age and anxiety level in elective surgical patients at Goeteng Taroenadibrata Hospital. Methods: This study used an analytical correlation research method with a quantitative approach. The sampling technique used Consecutive Sampling and 79 pre-anesthesia respondents were sampled for this study. The testused in this study is Kendall Tau Result: The results of the correlation test obtained a significance value for the level of anxiety with a P-value of 0.002 <0.05, and the majority of respondents experienced a moderate level of anxiety with a total of 42 respondents. Implications: From the results of the study, it can be seen that there is a correlation between age and anxiety levels of adult surgical patients at Goeteng Taroenadibrata Purbalingga Hospital. The findings of this study, it is expected to improve pre-operative care for patients in emergencies such as providing preoperative education to reduce anxiety in surgery patients. Keywords: Age;Anxiety;Surgery

Pengaruh Pendidikan Kesehatan Reproduksi Terhadap Perilaku Seksual Remaja: Studi Literatur

Latar belakang: Remaja adalah kelompok umur yang sedang dalam tahap perkembangan secara fisik, psikologis dan mental yang menjadikan remaja menjadi pribadi yang memiliki rasa keingintahuan yang tinggi sehingga remaja cenderung melakukan hal-hal berisiko salah satunya perilaku seksual pranikah. Salah satu faktor yang melatarbelakangi remaja menjadi terjerat perilaku seksual yang berisiko adalah kurangnya pengetahuan remaja yang dapat ditangani salah satu intervensi yaitu pendidikan kesehatanTujuan: Untuk melihat pengaruh dari pendidikan kesehatan reproduksi pada perilaku seksual yang dilakukan oleh remajaMetode: Peneliti menggunakan metode studi literatur yaitu dengan cara mengambil artikel melalui database online seperti Google Scholar, PubMed, dan Taylor and Francis Online dan seleksi artikel berdasarkan PRISMA sehingga didapatkan 4 artikel yang digunakan dalam studi ini dengan batasan waktu publikasi 7 tahun mulai dari tahun 2017 hingga 2023Hasil: Hasil uji univariat dan bivariat dari 4 artikel menunjukkan terdapat pengaruh pada pemberian pendidikan kesehatan tentang reproduksi terhadap perilaku seksual yang dilakukan oleh remajaImplikasi: Pendidikan kesehatan reproduksi dengan metode apapun terbukti berpengaruh dalam menurunkan perilaku seksual yang berisiko oleh remajaKata Kunci: Perilaku Seksual Remaja; Pendidikan Kesehatan

1301 What Can Be Done to Minimise the Mucosal Complications of Surgical Intervention Involved in the Treatment of Corneal Blindness Through Osteo-Odonto-Keratoprosthesis

Abstract Introduction Osteo-odonto-keratoprosthesis (OOKP), “tooth-in-eye surgery”, is a rare, complex surgery offered to certain patients with bilateral corneal blindness. Indications for the surgery include and range from: Steven-Johnson syndrome to end-stage ocular surface diseases. OOKP consists of two stages undertaken four months apart. Surgical complications can be divided into intraoperative and following stages 1 and 2. The most common postoperative complications include: Mucosal thinning/ulceration, mucosal overgrowth, and infection. We discuss, preventive methods which can be considered before the stage 2 intervention to minimise the rate of complications post OOKP surgery. Method A literature search was conducted in PubMed and Research gate to determine the main complications following involvement of maxillofacial surgery. Our key search criteria included mucosal complications post maxillofacial and oculoplastic surgical involvement. We selected for complications, post harvestation and transfer of the buccal mucosa onto the eye surface in OOKP. Results Three studies were selected, with a total of 130 patients. 58% experiencing surgical complications following stage 2. Study 1 demonstrated mucosal graft complications (22%), mucosal overgrowth(28%), mucosal thinning and ulceration(22%). Notably, 38% experienced no complications following the second stage. In the remaining studies, post-operative complications were divided into mucosal necrosis (33%) and mucosal overgrowth(13%), showing how complications can often interplay. Conclusions OOKP is a complex and laborious multi-disciplinary surgery, amenable to postoperative complications. Mucosal complications occur in a significant number of cases; therefore, it is important to anticipate these and endeavour to avert them. We outline how through prudent patient selection and pre-operative patient care (promotion and correction of dentition and oral health, examination of oral mucosa and maintenance of good mucosal graft health), outcomes for this surgery can be significantly improved.

Prevalence and factors associated with surgery anxiety in hospitalized patients: a point-prevalence study.

Preoperative anxiety is a challenging problem in the preoperative care of patients. Identifying risk factors helps nurses provide psychological support during the pre-operative visit so that stress can be reduced. This study aimed to determine the prevalence of surgical anxiety and related factors in hospitalized surgical patients. This research was designed as a point-prevalence study. The study was completed with 223 patients hospitalized in the surgical clinics of a tertiary hospital in Turkey. Surgical anxiety questionnaire (SAQ) and State-trait anxiety inventory (STAI) were used for the assessment of anxiety. Preoperative anxiety prevalence was 69.5% according to the SAQ and 49.3% according to STAI. Women, participants with no primary school education, those who were unemployed and had low income, those with no previous surgery, those living in fear of surgery, the participants who underwent major surgery and general anesthesia, and those who did not have knowledge about the surgical procedure and anesthesia had higher anxiety according to the two scales. A highly significant and positive correlation was found between total STAI and total SAQ. The importance of surgical anxiety for the health system, which affects two out of every three hospitalized patients, should not be underestimated. Therefore, national and global plans should be made to prevent and manage surgical anxiety.

Pre-Operative Anxiety and Health Problems of Patients Attending Hospitals of Kirkuk, Iraq

Background: Preoperative anxiety is a challenging problem in the preoperative care of patients. A common low level of anxiety is an expected reaction to unpredictable and potentially life-threatening circumstances, especially for a patient’s first surgical experience. It is a response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical symptoms. This study aimed to identify the anxiety prevalence among preoperative patients attending Kirkuk hospitals and associated factors.
 Objectives: To assess the anxiety level and identify the association between sociodemographic characteristics and patients’ anxiety.
 Method: A cross-sectional hospital-based study was conducted on 152 patients arranged for surgery at governmental hospitals of Kirkuk City by using a systematic random sampling procedure. Collecting data was performed from the 1st of January to the end of March 2023 by direct interview after informed consent was taken, and a proper questionnaire was used for the study. The data entry and analysis were done by using SPSS version 24(IBM STATA). Frequency percentage was used, and Chi-square was performed to assess the effect of association of variables. A p-value ≤ 0.05 was considered statistically significant.
 Results: Among 152 patients, the anxiety level was 27(17.8%), and one-fourth of them 38(25%) were at age 40-49 years. This study divided the anxiety levels into high, medium, and low. The anxiety levels were significantly higher among males (p-value 0.04), who were illiterate (P=0.011), and businessmen (P=0.001). Interestingly, the history of surgery was not significantly associated with state anxiety (p-value 0.96), those diagnosed with hypertension disorders (P=0.021) reported the highest proportion of anxiety.
 Conclusion: The level of anxiety showed nearly one-fifth, and the ratio of male: to female participants was 2:1, there was a significant association between the anxiety level and male gender, illiterates, Businessmen, and people who hypertension diagnosis report the highest proportion of anxiety level.

The Effect of Visits by Operating Room Nurses Before Cardiac Surgery on Anxiety and Pain Management

Further studies are needed in line with the Enhanced Recovery for Cardiac Surgery (ERCS) protocols with a view to reducing anxiety and opioid use in cardiac surgery patients. The present study investigates the effects of preoperative visits by operating room nurses to patients scheduled for cardiac surgery on postoperative anxiety, pain severity and frequency, and the type and dose of analgesic medication. This is a quasi-experimental study with a pretest-posttest control group design involving nonrandomized groups. The study was conducted in the Department of Cardiovascular Surgery of a Foundation University Hospital in Turkey between August 20, 2020 and April 15, 2021. Included in the study were patients selected based on a nonprobability sampling approach who met the study inclusion criteria (aged 18-75 years, no psychiatric diagnosis or drug use, first cardiovascular surgery experience, scheduled for elective surgery, up to five coronary anastomoses, literate and able to speak and understand Turkish, undergoing cardiovascular surgery with Cardiopulmonary Bypass (CPB)) determined by the researcher. The treatment group was visited preoperatively by operating room nurses, and followed-up for the first 72 hours after surgery. The intervention was effective in reducing postoperative state anxiety levels (P < .05). In the control group, each one-point increase in the preoperative state-anxiety level caused a 9% increase in the length of stay in the intensive care unit (P < .05). Pain severity increased as the preoperative state-anxiety and trait-anxiety levels, and the postoperative state-anxiety levels, increased (P < .05). While there was no significant difference in pain severity, the intervention proved to be effective in reducing pain frequency (P < .05). It was further noted that the intervention reduced the use of opioid and nonopioid analgesics for the first 12 hours (P < .05). The probability of using opioid analgesics increased 1.56 times (P < .05) with each one-point increase in pain severity reported by the patients. The participation of operating room nurses in preoperative patient care can contribute to the management of anxiety and pain and the reduction of opioids. It is recommended that such an approach be implemented as an independent nursing intervention given the potential contribution to ERCS protocols.

Factors affecting compliance to preoperative patient care guidelines among nurses working in surgical wards of a tertiary referral hospital in Nairobi, Kenya

BACKGROUND &#x0D; Worldwide, over 234 million surgical patients are operated on yearly with 3%-16% of them developing complications and other preventable surgical mistakes. To mitigate these negative surgical outcomes, pre-operative patient care guidelines (PPCG) have been developed. However, poor compliance with the guideline may lead to surgical errors. In Kenyatta National Hospital (KNH) 20% of surgical errors and 10% of cancelled surgeries are due to poor compliance with PPCG. Therefore, this study aimed to establish the level of compliance with PPCG and its associated factors among perioperative nurses at KNH. &#x0D; MATERIALS AND METHODS &#x0D; This was an analytical cross-sectional study that was conducted at the KNH surgical wards. The census method was utilized to collect data among 103 nurses and analyzed using SPSS version 22. Bivariate analysis with Fischer’s exact test was used for the correlation between the independent and dependent variables, with a p-value of &lt;0.05 being considered to be statistically significant at a 95% confidence interval. &#x0D; RESULTS &#x0D; Most [59(57.3%)] of the participants had low compliance to PPCG, with nurses’ experience (p=&lt;0.001), gender (p=0.02), level of education (p=&lt;0.001), having post-basic nursing training (p=0.02), not having training in PPCG (p=&lt;0.001) and knowledge on PPCG (p=&lt;0.001) being significantly associated with compliance to PPCG. &#x0D; CONCLUSION &#x0D; Most of the nurses have low compliance levels to PPCG, with nursing experience, nurses of the male gender, not having post-basic nursing training and not having training in PPCG use being the main contributing factors.

409 Effect of Social Determinants of Health on Post-Discharge Adverse Outcomes After Surgical Resection of Meningioma

INTRODUCTION: Understanding the role of social determinants of health (SDoH) is critical in informing preoperative care and postoperative follow-up for meningioma patients undergoing surgery. METHODS: A retrospective cohort study of adults presenting for meningioma resection from 1999-2020 was conducted. Primary outcomes included recurrence, readmission, and LTF (6-month and total). The main exposure of interest was Area Deprivation Index (ADI), a composite score of socioeconomic disadvantages. Additional SDoH factors analyzed included drive time to the hospital, insurance, and race. Multivariable logistic regression analyses for LTF and Cox regression for recurrence- and readmission-free survival were conducted. Covariates included age, WHO grade, and extent of resection. RESULTS: In total, 736 patients were included. Recurrence was observed in 90 patients, and 99 patients were readmitted following discharge. 121 patients missed initial and 6-month follow-up, but 107 of those eventually followed-up after six months. Fourteen patients were entirely LTF. ADI (OR = 1.11 per 10-point increase, 95% CI 1.02-1.21, p = 0.017) and drive time (OR = 1.03 per 30-minute increase, 95% CI 1-1.06, p = 0.022) predicted 6-month LTF. Drive time predicted complete LTF (OR = 1.04 per 30-minute increase, 95% CI 1-1.07, p = 0.017). Medicare/Military insurance predicted lower recurrence risk (HR = 0.43, 95% CI 0.23-0.81, p = 0.009) and higher readmission risk (HR = 2.00, 95% CI 1.17-3.41, p = 0.011). Other SDoH factors were not associated with recurrence or readmission. Lower WHO grade predicted lower recurrence risk (HR = 0.5, 95% CI 0.33-0.78, p = 0.002), while age (HR = 0.75 per 10-year increase, 95% CI 0.62-0.89, p &lt; 0.001) and gross total resection (HR = 0.56, 95% CI 0.35-0.9, p = 0.016) predicted lower readmission risk. CONCLUSIONS: Socioeconomically disadvantaged neighborhoods and further distance from the hospital were barriers to follow-up after meningioma resection. Other SDoH associated with readmission and recurrence are reported. Individualized follow-up plans should consider these SDoH to ensure care continuity and improve outcomes.

Perioperative anxiety and fear of death

An important field of anesthesiology but also of psychiatry and psychotherapy, is perioperative anxiety and especially the fear of death. In this review article the most important types of anxiety in the individual phases before, during and after surgery are presented and diagnostic aspects as well as risk factors are discussed. Benzodiazepines can classically be used therapeutically here, but in recent years the preoperative anxiety-reducing effects of e.g., supporting talks, acupuncture, aroma therapy, and relaxation methods have come more into focus, because benzodiazepines promote postoperative delirium, which significantly increases morbidity and mortality. Perioperative fear of death should, however, be given greater clinical and scientific attention in order not only to have a better understanding and preoperative care of patients, but also to reduce adverse consequences during surgery and afterwards.