Pre-op Research Articles

Association of Established Primary Care Use With Postoperative Mortality Following Emergency General Surgery Procedures

Sixty-five million individuals in the US live in primary care shortage areas with nearly one-third of Medicare patients in need of a primary care health care professional. Periodic health examinations and preventive care visits have demonstrated a benefit for surgical patients; however, the impact of primary care health care professional shortages on adverse outcomes from surgery is largely unknown. To determine if preoperative primary care utilization is associated with postoperative mortality following an emergency general surgery (EGS) operation among Black and White older adults. This was a retrospective cohort study that took place at US hospitals with an emergency department. Participants were Medicare patients aged 66 years or older who were admitted from the emergency department for an EGS condition between July 1, 2015, and June 30, 2018, and underwent an operation on hospital day 0, 1, or 2. The analysis was performed during December 2022. Patients were classified into 1 of 5 EGS condition categories based on principal diagnosis codes; colorectal, general abdominal, hepatopancreatobiliary, intestinal obstruction, or upper gastrointestinal. Mixed-effects multivariable logistic regression was used in the risk-adjusted models. An interaction term model was used to measure effect modification by race. Primary care utilization in the year prior to presentation for an EGS operation. In-hospital, 30-day, 60-day, 90-day, and 180-day mortality. A total of 102 384 patients (mean age, 73.8 [SD, 11.5] years) were included in the study. Of those, 8559 were Black (8.4%) and 93 825 were White (91.6%). A total of 88 340 patients (86.3%) had seen a primary care physician in the year prior to their index hospitalization. After risk adjustment, patients with primary care exposure had 19% lower odds of in-hospital mortality than patients without primary care exposure (odds ratio [OR], 0.81; 95% CI, 0.72-0.92). At 30 days patients with primary care exposure had 27% lower odds of mortality (OR, 0.73; 95% CI, 0.67-0.80). This remained relatively stable at 60 days (OR, 0.75; 95% CI, 0.69-0.81), 90 days (OR, 0.74; 95% CI, 0.69-0.81), and 180 days (OR, 0.75; 95% CI, 0.70-0.81). None of the interactions between race and primary care physician exposure for mortality at any time interval were significantly different. In this observational study of Black and White Medicare patients, primary care utilization had no impact on in-hospital mortality for Black patients, but was associated with decreased mortality for White patients. Primary care utilization was associated with decreased mortality for both Black and White patients at 30, 60, 90 and 180 days.

Cost-effectiveness of prehabilitation prior to elective surgery: a systematic review of economic evaluations

BackgroundPrehabilitation aims at enhancing patients’ functional capacity and overall health status to enable them to withstand a forthcoming stressor like surgery. Our aim was to synthesise the evidence on the cost-effectiveness of prehabilitation for patients awaiting elective surgery compared with usual preoperative care.MethodsWe searched PubMed, Embase, the CRD database, ClinicalTrials.gov, the WHO ICTRP and the dissertation databases OADT and DART. Studies comparing prehabilitation for patients with elective surgery to usual preoperative care were included if they reported cost outcomes. All types of economic evaluations (EEs) were included. The primary outcome of the review was cost-effectiveness based on cost–utility analyses (CUAs).The risk of bias of trial-based EEs was assessed with the Cochrane risk of bias 2 tool and the ROBINS-I tool and the credibility of model-based EEs with the ISPOR checklist. Methodological quality of full EEs was assessed using the CHEC checklist. The EEs’ results were synthesised narratively using vote counting based on direction of effect.ResultsWe included 45 unique studies: 25 completed EEs and 20 ongoing studies. Of the completed EEs, 22 were trial-based and three model-based, corresponding to four CUAs, three cost-effectiveness analyses, two cost–benefit analyses, 12 cost–consequence analyses and four cost-minimization analyses. Three of the four trial-based CUAs (75%) found prehabilitation cost-effective, i.e. more effective and/or less costly than usual care. Overall, 16/25 (64.0%) EEs found prehabilitation cost-effective. When excluding studies of insufficient credibility/critical risk of bias, this number reduced to 14/23 (60.9%). In 8/25 (32.0%), cost-effectiveness was unclear, e.g. because prehabilitation was more effective and more costly, and in one EE prehabilitation was not cost-effective.ConclusionsWe found some evidence that prehabilitation for patients awaiting elective surgery is cost-effective compared to usual preoperative care. However, we suspect a relevant risk of publication bias, and most EEs were of high risk of bias and/or low methodological quality. Furthermore, there was relevant heterogeneity depending on the population, intervention and methods. Future EEs should be performed over a longer time horizon and apply a more comprehensive perspective.Trial registrationPROSPERO CRD42020182813.

Implementing shared decision making for early-stage breast cancer treatment using a coproduction learning collaborative: the SHAIR Collaborative protocol

BackgroundShared decision making (SDM) in breast cancer care improves outcomes, but it is not routinely implemented. Results from the What Matters Most trial demonstrated that early-stage breast cancer surgery conversation aids, when used by surgeons after brief training, improved SDM and patient-reported outcomes. Trial surgeons and patients both encouraged using the conversation aids in routine care. We will develop and evaluate an online learning collaborative, called the SHared decision making Adoption Implementation Resource (SHAIR) Collaborative, to promote early-stage breast cancer surgery SDM by implementing the conversation aids into routine preoperative care. Learning collaboratives are known to be effective for quality improvement in clinical care, but no breast cancer learning collaborative currently exists.Our specific aims are to (1) provide the SHAIR Collaborative resources to clinical sites to use with eligible patients, (2) examine the relationship between the use of the SHAIR Collaborative resources and patient reach, and (3) promote the emergence of a sustained learning collaborative in this clinical field, building on a partnership with the American Society of Breast Surgeons (ASBrS).MethodsWe will conduct a two-phased implementation project: phase 1 pilot at five sites and phase 2 scale up at up to an additional 32 clinical sites across North America. The SHAIR Collaborative online platform will offer free access to conversation aids, training videos, electronic health record and patient portal integration guidance, a feedback dashboard, webinars, support center, and forum. We will use RE-AIM for data collection and evaluation. Our primary outcome is patient reach. Secondary data will include (1) patient-reported data from an optional, anonymous online survey, (2) number of active sites and interviews with site champions, (3) Normalization MeAsure Development questionnaire data from phase 1 sites, adaptations data utilizing the Framework for Reporting Adaptations and Modifications-Extended/-Implementation Strategies, and tracking implementation facilitating factors, and (4) progress on sustainability strategy and plans with ASBrS.DiscussionThe SHAIR Collaborative will reach early-stage breast cancer patients across North America, evaluate patient-reported outcomes, engage up to 37 active sites, and potentially inform engagement factors affecting implementation success and may be sustained by ASBrS.

Monitoring the effect of perioperative nutritional care on body composition and functional status in patients with carcinoma of gastrointestinal and hepatobiliary system and pancreas.

The significance of nutritional care in the management of cancer, particularly in the surgical treatment of abdominal cancer, is increasingly acknowledged. Body composition analysis, such as the Bioelectric impedance assay (BIA), and functional tests, e.g., handgrip strength, are used when assessing nutritional status alongside general and nutritional history, clinical examination, and laboratory tests. The primary approach in nutritional care is individually adjusted nutritional counselling and the use of medical nutrition, especially oral nutritional supplements. The aim of the study was to investigate the effects of perioperative nutritional care on body composition and functional status in patients with carcinoma of the gastrointestinal tract, hepatobiliary system, and pancreas. 47 patients were included, 27 received preoperative and postoperative nutritional counselling and oral nutritional supplements (Group 1), while 20, due to surgical or organisational reasons, received nutritional care only postoperatively (Group 2). The effect of nutritional therapy was measured with bioimpedance body composition and handgrip measurements. Group 2 had a higher average Nutritional Risk Screening (NRS) 2002 score upon enrolment (3 vs. 2 points); however, there was no difference when malnutrition was assessed using Global Leadership in Malnutrition (GLIM) criteria. There was a relative increase in lean body mass and fat-free mass index (FFMI) 7 days after surgery in group 1 (+4,2% vs. -2,1% in group 2). There was no difference in handgrip strength. Our results indicate that combined preoperative and postoperative nutritional care is superior to only postoperative nutritional care. It seems to prevent statistically significant lean mass loss 7 days after surgery but not after 14 days or 4 weeks.

A global analysis of nutrition support practices in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancy

Perioperative nutritional care has been identified as an important factor in the management of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Nevertheless, there is no published consensus on best practice for nutritional management specific to this patient group. The purpose of this study was to identify the current nutrition care practices among international centres performing CRS and HIPEC for patients with peritoneal malignancy. An online survey was developed and sent to experienced CRS and HIPEC centres. The survey questions covered clinician and institution demographics, formal nutrition care pathways, pre-operative nutrition care, post-operative nutrition support and post-discharge nutritional follow-up. Eighty-two centres were contacted, and 42 responses were received. Respondents were from 20 different countries and were mostly dietitians (71%). Nutrition assessments were frequently completed (52% pre-operatively and 86% post-operatively) and most centres used a validated nutrition screening or assessment tool (79%). Perioperative nutrition support with respect to the use of enteral nutrition, parenteral nutrition and enhanced recovery after surgery varied widely between centres. The use of routine parenteral and enteral nutrition was significantly higher in Europe compared with other locations (p=0.028). Nutrition care is pivotal and has been positively integrated into the complex management of patients undergoing CRS and HIPEC globally, however variation in practice is evident. The findings highlight a unique opportunity to collaboratively investigate the role nutrition plays in determining outcomes and to identify the most appropriate nutrition support methods to achieve improved clinical outcomes for these high-risk patients.

Treatment of iron deficiency in patients scheduled for pancreatic surgery: implications for daily prehabilitation practice in pancreatic surgery

BackgroundPreoperative anemia is a frequent complication in pancreatic surgical patients, and it adversely affects morbidity, mortality, and postoperative red blood cell (RBC) transfusion rates. Iron deficiency (ID) is often the underlying cause of anemia and constitutes a modifiable risk factor.MethodsSingle-center, longitudinal prospective cohort study conducted between May 2019 and August 2022 at the University Medical Center Groningen in the Netherlands. Patients scheduled for pancreatic surgery were referred to the outpatient prehabilitation clinic for preoperative optimization of patient-related risk factors. Patients were screened for anemia (< 12.0 g/dL in women and < 13.0 g/dL in men) and ID (either absolute [ferritin < 30 µg/L] or functional [ferritin ≥ 30 µg/L + transferrin saturation < 20% + C-reactive protein > 5 mg/L]). Intravenous iron supplementation (IVIS) (1,000 mg ferric carboxymaltose) was administered to patients with ID at the discretion of the consulting internist. Pre- and postoperative hemoglobin (Hb) levels were assessed, and perioperative outcomes were compared between patients receiving IVIS (IVIS-group) or standard care (SC-group).ResultsFrom 164 screened patients, preoperative anemia was observed in 55 (33.5%) patients, and in 23 (41.8%) of these patients, ID was the underlying cause. In 21 patients, ID was present without concomitant anemia. Preoperative IVIS was administered to 25 patients, out of 44 patients with ID. Initial differences in mean Hb levels (g/dL) between the IVIS-group and SC-group at the outpatient clinic and one day prior to surgery (10.8 versus 13.2, p < 0.001, and 11.8 versus 13.4, p < 0.001, respectively) did not exist at discharge (10.6 versus 11.1, p = 0.13). Preoperative IVIS led to a significant increase in mean Hb levels (from 10.8 to 11.8, p = 0.03). Fewer SSI were observed in the IVIS-group (4% versus 25.9% in the SC-group, p = 0.02), which remained significant in multivariable regression analysis (OR 7.01 (1.68 – 49.75), p = 0.02).ConclusionID is prevalent in patients scheduled for pancreatic surgery and is amendable to preoperative correction. Preoperative IVIS increased Hb levels effectively and reduced postoperative SSI. Screening and correction of ID is an important element of preoperative care and should be a standard item in daily prehabilitation practice.

Larsen Syndrome and Associated Spinal Deformities.

Larsen syndrome is a rare genetic disorder that affects the connective tissue within the body. The present narrative review aims to examine the genetic basis of Larsen syndrome, clarify its symptoms, and define all the existing therapeutic approaches. A comprehensive search was performed in the PubMed database. Inclusion criteria considered molecular and clinical studies, management and surgical treatment of related deformities, case reports of patients with the syndrome, reviews of the associated anomalies, articles whose full text is available in PubMed, and articles published in the English language. Larsen syndrome is caused by mutations in the FLNB gene, which encodes the cytoskeletal protein filamin B, crucial in the development of the skeleton. Symptoms include joint dislocations, characteristic facial features and anomalies of the spine. Larsen syndrome may be conservatively treated initially, although surgical intervention is usually required. Various surgical techniques, including posterior spinal fusion, anterior decompression, circumferential arthrodesis, and single-stage 360° fixation, have been proposed along with growth-sparing procedures. Preoperative and postoperative care and education ensure optimal results. Further research is needed to identify novel therapeutic modalities for this condition.

General Anesthetic Care of Obese Patients Undergoing Surgery: A Review of Current Anesthetic Considerations and Recent Advances.

Obesity has long been linked to adverse health effects over time. As the prevalence of obesity continues to rise, it is important to anticipate and minimize the complications that obesity brings in the anesthesia setting during surgery. Anesthetic departments must recognize the innumerable risks when managing patients with obesity undergoing surgery, including anatomical and physiological changes as well as comorbidities such as diabetes, cardiovascular diseases, and malignancies. Therefore, the purpose of this review is to analyze the current literature and evaluate the current and recent advances in anesthetic care of obese patients undergoing surgery, to better understand the specific challenges this patient population faces. A greater understanding of the differences between anesthetic care for obese patientscan help to improve patient care and the specificity of treatment. The examination of the literature will focus on differing patient outcomes and safety precautions in obese patients as compared to the general population. Specifically highlighting the differences in pre-operative, intra-operative, and post-operative care, with the aim to identify issues and present possible solutions.

A randomised controlled trial of prehabilitation in patients undergoing elective cardiac surgery.

The feasibility, safety and efficacy of prehabilitation in adult patients awaiting elective cardiac surgery are unknown. A total of 180 participants undergoing elective cardiac surgery were allocated randomly to receive either standard pre-operative care or prehabilitation, consisting of pre-operative exercise and inspiratory muscle training. The primary outcome was change in six-minute walk test distance from baseline to pre-operative assessment. Secondary outcomes included change in inspiratory muscle strength (maximal inspiratory pressure); sarcopenia (handgrip strength); quality of life and compliance. Safety outcomes were pre-specified surgical and pulmonary complications and adverse events. All outcomes were assessed at baseline; at pre-operative assessment; and 6 and 12 weeks following surgery. Mean (SD) age was 64.7 (10.2) years; 33/180 (18%) were women. In total, 65/91 (71.4%) participants who were allocated to prehabilitation attended at least four of eight supervised in-hospital exercise classes; participants aged > 50 years were more likely than younger participants to attend (odds ratio (95%CI) of 4.6 (1.0-25.1)). Six-minute walk test was not significantly different between groups (mean difference (95%CI) -7.8 m (-30.6-15.0), p = 0.503) in the intention-to-treat analysis. Subgroup analyses based on tests for interaction indicated improvements in six-minute walk test distance were larger amongst sarcopenic patients in the prehabilitation group (p = 0.004). Change in maximal inspiratory pressure from baseline to all time-points was significantly greater in the prehabilitation group, with the greatest mean difference (95%CI) observed 12 weeks after surgery (10.6 cmH2 O (4.6-16.6) cmH2 O, p < 0.001). There were no differences in handgrip strength or quality of life up to 12 weeks after surgery. There was no significant difference in postoperative mortality (one death in each group), surgical or pulmonary complications. Of 71 pre-operative adverse events, six (8.5%) were related to prehabilitation. The combination of exercise and inspiratory muscle training in a prehabilitation intervention before cardiac surgery was not superior to standard care in improving functional exercise capacity measured by six-minute walk test distance pre-operatively. Future trials should target patients living with sarcopenia and include inspiratory muscle strength training.

Paper 28: Both Hamstring Autograft Combined with Lateral Extra-Articular Tenodesis and Quadriceps Autograft Lead to Lower Graft Re-Tear Rates and Pivot Shift After ACL Reconstruction Compared to Hamstring Autograft Alone

Paper 28: Both Hamstring Autograft Combined with Lateral Extra-Articular Tenodesis and Quadriceps Autograft Lead to Lower Graft Re-Tear Rates and Pivot Shift After ACL Reconstruction Compared to Hamstring Autograft Alone

Effectiveness of an Instructional Module on Knowledge and Anxiety of Caregivers of Children Undergoing Cardiac Catheterization – An Experimental Study

Background: Diagnosis of cardiovascular disorders in children is a very stressful time for the entire family. During this period family caregivers are anxious about their child’s condition. At this time, nurses play an important role to educate the parents or caregivers about the child’s health, procedure that has to be performed, and pre- and post-operative care after procedure. This study was conducted to assess the effectiveness of an “instructional module” on knowledge and anxiety of caregivers of children undergoing cardiac catheterization. Materials and Methods: Caregivers of children with congenital heart disease were randomly enrolled in two groups with 30 caregivers in each control and experimental group. Preoperative knowledge and anxiety in both the groups were assessed by a self-structured questionnaire and the State-Trait Anxiety Inventory. An instructional module in the form of a booklet regarding cardiac catheterization was developed and administered to the experimental group while the control group received routine care instuctions. Caregivers’ postintervention knowledge was assessed by a structured knowledge questionnaire. Results: Median knowledge score was 2 (2–2) in the control group and 2 (1–2) in the experimental group among caregivers of the children during preintervention phase. The median anxiety score of the caregivers of children underwent cardiac catheterization during preintervention phase was 57.50 (47–61) in the control group and 53 (47.75–56) in the experimental group. The results revealed that there was a significant improvement in knowledge score regarding cardiac catheterization procedure and also there was reduction in the level of anxiety among caregivers in the postintervention experimental group (P &lt; 0.001). Conclusion: The study suggests that the “instructional module” is effective in reducing the anxiety and improving the knowledge levels of caregivers regarding the preoperative and postoperative care of children who underwent cardiac catheterization.

Preoperative Code Status Discussion Workflows: Targets for Improvement in Multidisciplinary Pathways.

Discussion of perioperative code status is an important element of preoperative care and a component of the American College of Surgeons' Geriatric Surgery Verification (GSV) program. Evidence suggests code status discussions (CSDs) are not routinely performed and are inconsistently documented. Because preoperative decision making is a complex process spanning multiple providers, this study aims to utilize process mapping to highlight challenges associated with CSDs and inform efforts to improve workflows and implement elements of the GSV program. Using process mapping, we detailed workflows relating to (CSDs) for patients undergoing thoracic surgery and a possible workflow for implementing GSV standards for goals and decision-making. We generated process maps for outpatient and day-of-surgery workflows relating to CSDs. In addition, we generated a process map for a potential workflow to address limitations and integrate GSV Standards for Goals and Decision Making. Process mapping highlighted challenges associated with the implementation of multidisciplinary care pathways and indicated a need for centralization and consolidation of perioperative code status documentation.

Poster 333: Outcomes of Anterior Closing Wedge High Tibial Osteotomy in Patients Undergoing ACL Revision Reconstruction

Objectives: Graft failure rates following anterior cruciate ligament (ACL) reconstruction have been reported up to 30%. According to the literature, one anatomic variant linked to graft reinjury is a high posterior tibial slope. As a result, surgeons are exploring the effectiveness of slope reducing high tibial osteotomy (HTO) to reduce the subsequent reinjury risk. While cadaveric models indicate that this procedure decreases the forces across the ACL graft, there is limited evidence demonstrating its efficacy in clinical trials. Therefore, the purpose of this study was to compare self-reported patient outcomes between patients undergoing ACL revision surgery with a slope reducing high tibial osteotomy (ACL+HTO) and matched controls undergoing revision ACL reconstruction without slope reducing HTO. We hypothesized that patients undergoing ACL+HTO would exhibit similar outcomes with a low failure rate when compared to their matched counterparts. Methods: A retrospective matched-case control study was conducted for patients undergoing ACL revision reconstruction from 2018 to 2021, utilizing a single surgeon database (n = 1,781). Patients in the HTO group were included if they were at least one year out from surgical ACL reconstruction and slope reducing osteotomy. Patients were excluded if they had a primary ACL reconstruction or no concomitant ACL reconstruction with an HTO. Patients in the ACL+HTO group were age, gender, and setting-matched to a control group of patients undergoing revision ACL reconstruction. Descriptive patient demographic and surgical data were obtained, including pre/postoperative posterior tibial slope (o) for the HTO group. Complications and injury surveillance was conducted throughout the postoperative follow-up period. Primary outcome measures included the Single Assessment Numeric Scale (SANE), and graft failure rates at 24 months. Secondary outcomes included return to sport rate and level, and postoperative complications (infection, loss of motion, deep vein thrombosis, etc). Generalized linear models were conducted using parametric and nonparametric equivalents to compare baseline and outcome measures between groups with an a-priori alpha level of .05. Results: From a group of 364 revision ACL reconstructions, 9 patients met the inclusion criteria for the ACL+HTO group (Table 1). This group was age, gender and revision matched to 30 patients in the control group. Baseline comparisons revealed that the ACL control group weighed more than the experimental group (198.2 ±26.4 vs 183.7 ±21.7, P &lt;.001), however all other comparisons were not statistically different. The mean pre op posterior tibial slope was 19.2o ±4.1o and 7.7o ±2.3o following HTO (mean diff: -11.5o, P &lt;.001). Mean time to follow-up was 1.82 ±0.3 years. At follow-up, there were no statistical differences in self-reported knee function (SANE score), graft reinjury rate, rate of return to sport, or level of return to sport between groups (Table 2). There were no graft reinjuries reported in the ACL+HTO group, and approximately 85.8% returned to some level of sporting activity with 42% returning to a level I or II cutting and pivoting sport. Conclusions: Preliminary evidence provided in the current study suggests that slope reducing HTO in the setting of revision ACL reconstruction for large posterior tibial slope deformities is effective at correcting malalignment and avoiding graft failure out to 2 years. This procedure also holds promise to allow a majority of patients to return to various levels of sporting activities. To our knowledge, this is the first comparative study comparing the intermediate outcomes of this subpopulation to a matched revision ACL cohort. While these data do provide evidence for ongoing investigation, it is important to note that this pilot study is underpowered and we strongly recommend the performance of larger clinical trials to confirm these results. [Table: see text][Table: see text]

(052) Characterization of Female Sexual Dysfunction Associated with Spinal Pathology and Surgery

Abstract Introduction Sexuality and sexual function are understood as fundamental facets of the human experience. The disruption of sexual function is socially disruptive and emotionally distressing. Studies demonstrate the connection between adverse sexual function and medical conditions such as diabetes and heart disease, however in the areas of spinal pathologies, sexual function remains mostly studied in males or as a collective of male and female patients. The male and female sexual experience may be quite different, and a combined cohort may not appropriately characterize female-specific dysfunction. Objectives Sexual dysfunction associated with spinal pathologies in males is well studied. However, little research exists addressing this issue in females. This review presents data on female sexual dysfunctions associated with spinal pathologies. Methods PubMed and Google Scholar identified case reports and primary studies evaluating female sexual dysfunction associated with spinal pathology as well as surgical intervention success were reviewed to contextualize and characterize female sexual dysfunction in this population. Results Female sexual dysfunction has been cited to arise from the spine due to traumatic etiologies, malignant tumors, and benign tumors with and without bony involvement. Surgeons identify the absence of bowel, bladder, and/or sexual dysfunction as one of the key preoperative predictors in maintenance or improvement of neurologic status, however sexuality is rarely addressed in the pre-operative or post-operative neurosurgical care plan. In data generated from males and females with spinal stenosis and degenerative spine disease, over half of patients report pain with sexual activity. Post-operatively, there appears to be a significant decrease in sexual pain. However, the data do not separately report results for females versus males. Importantly, while pain can hinder sexual activity in females, there also are other sexual issues, including desire and subjective arousal, lubrication, orgasm, and satisfaction that should be explored. By the use of the Female Sexual Function Index (FSFI), one study compared sexually active females with protruding disc herniation with healthy females. These data showed a lower FSFI, a lower number of weekly sexual intercourse and a higher score for depression in women with this condition. Further detangling painful intercourse from other types of sexual dysfunction, case studies have shown pre and post op sexual dysfunction from perianal hypoesthesia, and reduced sensation in the sacral area associated with an L5-S1 disc pathology. It is suggested that these other types of sexual dysfunction with lack of coital pain fail to improve after surgical intervention. Conclusions There is a gender disparity when addressing sexual dysfunction and the implications of spinal surgery. The lack of high-quality research with adequate numbers of female participants that appropriately characterizes the nuances of female sexual dysfunction across various spinal pathologies, with post- surgical intervention analysis and consideration of surgical approach, necessitates consideration for study. Pre-op and post-op sexual history should be included for all women with spinal health issues. Disclosure No.

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.

The association between preoperative multidisciplinary team care and patient outcome in frail patients undergoing cardiac surgery

ObjectiveTo evaluate the influence of preoperative multidisciplinary team (MDT) care on perioperative management and outcomes of frail patients undergoing cardiac surgery. BackgroundFrail patients are at increased risk for complications and poor functional outcome after cardiac surgery. In these patients, preoperative MDT care may improve outcomes. MethodsBetween 2018 and 2021, 1168 patients aged 70 years or older were scheduled for cardiac surgery, of whom 98 (8.4%) frail patients were referred for MDT care. The MDT discussed surgical risk, prehabilitation, and alternative treatment. Outcomes of MDT patients were compared with 183 frail patients (non-MDT group) from a historical study cohort (2015-2017). Inverse probability of treatment weighting was used to minimize bias from nonrandom allocation of MDT versus non-MDT care. Outcomes were severe postoperative complications, total days in hospital after 120 days, disability, and health-related quality of life after 120 days. ResultsThis study included 281 patients (98 MDT and 183 non-MDT patients). Of the MDT patients, 67 (68%) had open surgery, 21 (21%) underwent minimally invasive procedures, and 10 (10%) received conservative treatment. In the non-MDT group, all patients had open surgery. Fourteen (14%) MDT patients experienced a severe complication versus 42 (23%) non-MDT patients (adjusted relative risk, 0.76; 95% CI, 0.51-0.99). Adjusted total days in hospital after 120 days was 8 days (interquartile range, 3-12 days) versus 11 days (interquartile range, 7-16 days) for MDT and non-MDT patients, respectively (P = .01). There was no difference in disability or health-related quality of life. ConclusionsPreoperative MDT care for frail patients undergoing cardiac surgery is associated with alterations in surgical management and with a lower risk for severe complications.

Perceptions and Attitudes of Patients and Health Care Stakeholders on Implementing a Telehealth Service for Preoperative Evaluation: A Qualitative Analysis.

Studies suggest that preoperative evaluation can be effectively conducted through telehealth. As the COVID-19 pandemic has accelerated digital transformation, we hypothesize that a new telehealth model of care may be feasibly implemented for preoperative evaluation at our institution. This qualitative study seeks to evaluate the attitudes and perception of elective surgery patients and health care providers toward telehealth conducted for preanesthesia evaluation. At a tertiary women's hospital in Asia, health care providers and elective surgery patients were recruited by convenience and snowball sampling to undergo one-on-one semistructured interviews regarding a new telehealth model of care for preanesthesia evaluation, under-pinned by the Normalization Process Theory. Data were analyzed, coded, and consolidated into themes using the framework analysis method by a team of four researchers from diverse backgrounds. Twenty-five interviews were conducted among 10 patients and 15 health care participants. Ninety-five codes were identified, consolidated into four themes that connect to guide the implementation of a new telehealth pathway for preoperative care, mapped to the Normalization Process Theory. The themes pertain to advantages of telehealth workflow (coherence), requisites for new telehealth workflow (coherence, collective action), barriers to implementation (cognitive participation, collective action), and enablers of implementation (cognitive participation, collective action). All participants were receptive to telehealth, but health care participants expressed concern about the impact of additional tasks on current clinical workload. Training in videoconferencing was deemed essential by both patients and health care providers. The study has provided insights into levels of coherence and cognitive participation among patients and health care providers. The telehealth workflow should be redesigned, considering systems' constraints and stakeholders' needs. Greater buy-in is needed to gain health care providers' commitment for collective action. Clinicaltrials.gov identifier: NCT05781789.

KNOWLEDGE OF NURSING STUDENTS ABOUT INTESTINAL ELIMINATION STOMAS

Objective: To investigate the knowledge of nursing students about intestinal elimination stomas. Method: Descriptive, exploratory, analytical study, with a quantitative approach, carried out in a public higher education institution in Piauí, Brazil, with 115 nursing students between the eighth and the tenth period of the course. The data collection was carried out through an online questionnaire composed of two instruments, one about the sociodemographic and school profile of the students, and the other about knowledge on intestinal ostomies or elimination. Data analysis was carried out through descriptive analysis (absolute and relative frequencies, means and standard deviation) and inferential analysis, in order to verify association between variables, with χ2 and Fisher’s exact tests. Results: Most nursing students have a deficit regarding aspects related to preoperative and immediate and mediate postoperative care. There was a statistically significant difference in the academic performance index variable, and it was observed that students with academic performance greater than 9 obtained a higher number of correct answers compared to the others. Conclusion: There are knowledge gapsamong nursing students, especially in nursing care in preoperative care, and in the immediate and mediate postoperative period, which in turn can compromise the quality of care provided.

Oral care reduces incidence of pneumonia after esophagectomy: systematic review and meta-analysis.

Post-operative pneumonia after esophagectomy is a major contributor to morbidity and mortality. Prior studies have demonstrated a link between the presence of pathologic oral flora and the development of aspiration pneumonia. The objective of this systematic review and meta-analysis was to evaluate the effect of pre-operative oral care on the incidence of post-operative pneumonia after esophagectomy. A systematic search of the literature was performed on September 2, 2022. Screening of titles and abstracts, full-text articles, and evaluation of methodological quality was performed by two authors. Case reports, conference proceedings, and animal studies were excluded. A meta-analysis of peri-operative oral care on the odds of post-operative pneumonia after esophagectomy was performed using Revman 5.4.1 with a Mantel-Haenszel, random-effects model. A total of 736 records underwent title and abstract screening, leading to 28 full-text studies evaluated for eligibility. A total of nine studies met the inclusion criteria and underwent meta-analysis. Meta-analysis revealed a significant reduction in post-operative pneumonia among patients undergoing pre-operative oral care intervention compared to those without an oral care intervention (OR 0.57, 95% CI 0.43-0.74, p < 0.0001; I2 = 49%). Pre-operative oral care interventions have significant potential in the reduction of post-operative pneumonia after esophagectomy. North American prospective studies, as well as studies on the cost-benefit analysis, are required.