Preoperative Patient Education Research Articles

Implementation of an innovative ERAS protocol in cardiac surgery: A qualitative evaluation from patients' perspective.

Enhanced recovery after surgery (ERAS) protocols aim to optimize the recovery process for patients after surgical interventions and focus on patient-centered care. In cardiac surgery, the ERAS concept is still in its early stages. Our university hospital has implemented an innovative ERAS protocol for minimally invasive heart valve surgery since 2021. Therefore, our study aimed to comprehensively assess the patient experience within this newly established ERAS protocol and focused on exploring and understanding the nuances of optimal healthcare delivery under the ERAS framework from the unique perspective of the patients undergoing cardiac surgery. Qualitative research was conducted using semi-structured interviews. Data was analyzed using Kuckartz´s qualitative content analysis. The following main themes emerged from the 12 completed patient interviews: 1) information and communication flow, 2) perioperative patient care, and 3) rehabilitation. Patients found the pre-operative patient education and preconditioning very helpful. Patients were satisfied with the flow of information throughout the whole perioperative care process. Most patients expressed a need for more information about the course of surgery. The intensity of care provided by different professions was perceived as optimal. The support and inclusion of relatives in perioperative care were considered crucial. Patients appreciated the direct transfer to the rehabilitation and mainly were able to cope with daily life tasks afterward. In summary, all patients experienced the ERAS protocol positively, and their healthcare process was well established. Active inclusion and education of patients in their treatment can improve patient empowerment. Two further aspects that deserve major consideration in the healthcare process are the inclusion of relatives and interprofessional cooperation.

Critical Portions of a Foot or Ankle Surgical Procedure From Patient and Surgeon Perspectives

Background: Over the past decade, overlapping procedures in orthopaedic surgery have come under increased public scrutiny. Central to this discussion is what should constitute a “critical portion” of any surgical procedure—a definition which may differ between patients and surgeons. This study therefore aimed to assess which components of three common foot and ankle procedures are considered “critical” from both the patient and surgeon perspectives. Methods: For this survey-based study, questionnaires were administered to patients who presented to an orthopaedic foot and ankle clinic and separately administered to foot and ankle surgeons through e-mail. The questionnaires broached all steps involved in three common foot and ankle procedures: open reduction and internal fixation of ankle fracture, Achilles tendon repair, and ankle arthroscopy. Respondents were asked to characterize each step as “always critical,” “often critical,” sometimes critical,” rarely critical,” or “never critical.” A combined “always critical” and “often critical” response rate of greater than 50% was used to define a step as genuinely critical. Patient and surgeon responses were thereafter compared using Mann-Whitney U and Kruskal-Wallis tests (P-value <0.05 was considered significant). Results: Notably, both patients and surgeons considered informed consent, preoperative marking of the surgical site, preoperative time-out, surgical soft-tissue dissection, and certain procedure-specific steps (critical portions) of these procedures. By contrast, only patients considered skin incision and wound closure to be critical steps. Conclusion: Patients and surgeons were largely in agreement as to what should comprise the critical portions of several common foot and ankle procedures. Certain discrepancies did exist, however, such as skin incision and closure, and both groups were also in general agreement regarding what was not considered a critical component of these operations. Such findings highlight a potential opportunity for improved preoperative patient education and patient-physician communication. Level of evidence: Level IV: Evidence from well-designed case-control or cohort studies.

Basic principles of surgical treatment of distal radius fractures

Distal radius fractures are one of the most frequent fractures of the upper extremities. The decision for conservative or surgical treatment is made after appropriate diagnostics using conventional radiographic and usually computed tomography imaging examinations. If the indications for surgical treatment are present, various options for reduction and fixation are available. The spectrum ranges from closed to open procedures up to accompanying arthroscopic support. Appropriate preoperative patient education about the procedure and the planned postinterventional treatment is essential. The goal of treatment is to restore wrist function while maintaining mobility and strength with alow risk of complications. All surgical procedures share the principle of reduction to restore anatomical relationship followed by fixation. Closed procedures include fixation with Kirschner wires and the construction of an external fixator. Volar locking plate osteosynthesis has become established in recent years as the method of choice for the majority of the fractures to be treated. For special fracture patterns and the treatment of accompanying injuries, arthroscopic support can be indicated. There is no uniform consensus on the best choice of procedure. This article discusses the possible procedures including the approaches, fixation techniques and specific follow-up treatment.

Quality improvement lessons from Canadian thyroid and parathyroid surgery legal decisions

BackgroundThis is the first study of Canadian thyroid and parathyroid surgery legal decisions, and the first study of surgical malpractice using the Canadian Legal Information Institute (CanLII) database. The objective was to identify quality improvement opportunities in surgical practice, to increase patient safety and satisfaction. MethodsLegal decisions relating to thyroid and parathyroid surgery in the CanLII database were screened. Cases were included if a surgeon was listed as applicant or respondent; they related to pre-, intra-, or post-operative management of thyroid or parathyroid disease; and malpractice was alleged. Cases were excluded if surgery was mentioned incidentally or for non-surgical focus. ResultsOf the 347 unique legal decisions screened, 14 met inclusion and exclusion criteria. Surgeries occurred between 1976 and 2012, with 13 thyroid surgeries, 1 parathyroidectomy, and 4 mortalities. ConclusionsQuality improvement lessons include communication, pre-operative patient education and documentation of risks discussed, and in-person assessment of complications.

Status and content of outpatient preoperative education for rectal cancer patients undergoing stoma surgery provided by Japanese wound, ostomy, and continence nurses: a cross-sectional study

BackgroundPreoperative education can improve postoperative quality of life in patients undergoing stoma surgery. However, the prevalence and when, where, and how preoperative education is implemented are unclear. Therefore, this study aimed to assess the current status of outpatient preoperative education for patients undergoing stoma surgery for rectal cancer as perceived by nurses. Additionally, it sought to identify the information provided by Japanese healthcare providers as a part of preoperative education.MethodsThis cross-sectional study included 1,716 wound, ostomy, and continence nurses (WOCNs) in charge of stoma clinics at Japanese hospitals. Unsigned self-administered survey forms were mailed to the participants, and paper- or web-based responses were obtained. The main questions included: overview of the participants and their facilities, provision of outpatient preoperative education, status of implementation, and preoperative education components. To examine the factors associated with preoperative education, the independent variable was the presence or absence of preoperative education in the clinic, and the explanatory variables were the years of experience as a nurse, years of experience as a WOCN, type of hospital, number of beds, and number of intestinal stoma surgeries per year. Regression analysis was performed.ResultsWe received 773 valid responses (valid response rate: 45%). Duration of experience as a nurse and as a WOCN were 24.6 and 10.9 years, respectively. Outpatient preoperative education was provided by 24% of the participants. Most preoperative education sessions were conducted for patients or caregivers. Preoperative education took 31–60 min per patient, and one to five patients received preoperative education each month. Booklets, ostomy appliances, and stoma models/dolls were used as supplementary materials for preoperative education. The most frequently mentioned components of preoperative education were stoma care, daily life, social security, stoma clinic, traveling and going out, quality of life after stoma surgery, and precautions for medical treatment. In addition, education on the use of restrooms on the go, disaster preparedness, defecation disorders after restorative proctectomy, and complications after stoma closure were considered necessary.ConclusionsThe implementation rate of outpatient preoperative education was low (24%). Future challenges include the development of specific educational content and procedures suitable for the Japanese medical environment and the establishment of preoperative medical care teams for stoma surgery to promote the provision of outpatient preoperative education.

The Effect of Preoperative Education on Preoperative Anxiety in Patients Waiting for Surgery: A literature Review

Context: Among patients undergoing surgery, preoperative anxiety (PA) is one of the most common psychological problems that can negatively impact the patient's physical health and the operation's outcome. Preoperative patient education (PPE) is a way to reduce PA, which has many advantages over pharmaceutical methods. Therefore, this study aimed to evaluate the effectiveness of PPE on PA in patients who are candidates for surgery by reviewing similar previous studies. Evidence Acquisition: The data in this narrative review were collected by searching past studies in reliable international databases, including Web of Science, Science Direct, Scopus, PubMed, and Google Scholar, in the last two decades. In the first stage of the search, 248 articles and scientific reports were received, and then 30 articles were selected as final studies by considering the inclusion and exclusion criteria. Results: In most previous similar studies, PPE significantly reduced PA in patients who are candidates for surgery. However, the findings of a small number of studies also showed that PPE had little positive effect, no effect, or negative effect on PA control. There were different methods to provide information to patients before surgery, and the efficiency and application of each were different based on the demographic characteristics of the patients. Conclusions: Based on the findings, appropriate training methods can reduce the level of PA in patients who are candidates for surgery. However, in some past studies, providing information about the surgical procedure may increase patients' PA. Therefore, nurses or medical staff with more contact with patients are suggested to have sufficient experience and knowledge in providing information and choosing the training method for patients before surgery.

Implementing evidence-based pre-operative education in hospitalized patients undergoing total knee replacement: a best practice implementation project

ABSTRACT Introduction: Pre-operative education is a key factor influencing post-operative recovery, patient expectations of surgery, and patient satisfaction. Although there are guidelines for the pre-operative education of patients undergoing knee replacement, pre-operative education of patients remains suboptimal. Objectives: This study aimed to improve the knowledge and skills of health care providers and patients undergoing elective knee replacement. The project used pre-operative education to increase compliance with best practices. Methods: This project was conducted from January to October 2022 in the orthopedic department of a tertiary hospital in China. The project was conceptually guided by the JBI Model of Evidence-Based Healthcare, while the JBI Evidence Implementation Framework was used to guide the implementation. Two audit criteria were developed for the baseline and follow-up audits, which assessed 20 patients undergoing elective knee replacement. Results: A comparison of the audit outcomes revealed that for Criterion 1, the percentage of patients receiving pre-operative education in both audits was 100%. For Criterion 2, the compliance rate increased significantly from 0% in the baseline audit to 90% in the follow-up audit. Conclusions: A clinical audit is an effective approach to improving compliance with recommended best practices. Leadership, team resource management, education, and monitoring were helpful in implementing the best practices. Further audits will need to be conducted to maintain practice changes and ensure that the project is sustainable.

The Efficacy of Preoperative Video-Based Opioid Counseling on Postoperative Opioid Consumption After Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

BackgroundThere are myriad strategies to reduce opioid consumption after total knee arthroplasty (TKA). Recent studies have suggested that preoperative counseling may reduce opioid use after a variety of orthopedic procedures. The purpose of this study was to investigate whether preoperative video-based patient education regarding opioid use and abuse reduces opioid consumption after TKA. MethodsIn this prospective randomized controlled trial, patients were randomized before TKA to either receive preoperative video-based counseling or not. Counseling involved a pretaped 5-minute video that educated patients on statistics regarding the “opioid epidemic” and discussed safe use and alternatives to opioids after TKA. There were no significant differences in baseline patient demographics between groups. All patients received a similar multimodal perioperative pain management protocol and completed a daily diary for 2 weeks postoperatively. Diary records measured pain levels using a visual analog score, opioid consumption, side effects experienced, and patient opinion and satisfaction regarding their pain control. ResultsPatients in the counseling group consumed significantly less morphine milligram equivalents on postoperative days 0 to 3 (78.8 versus 106.1, P = .020) and in week one postoperatively (129.9 versus 180.7, P = .028), with a trend of less consumption over 2 weeks postoperatively (186.9 versus 239.1, P = .194). There were no significant differences in the number of patients requiring refills, side effects, or daily pain levels between the 2 groups. ConclusionsThis study found significantly decreased opioid consumption within the first week after TKA in patients who received preoperative video counseling.

Utilization of 3D printing technology in hepatopancreatobiliary surgery.

The technology of three-dimensional (3D) printing emerged in the late 1970s and has since undergone considerable development to find numerous applications in mechanical engineering, industrial design, and biomedicine. In biomedical science, several studies have initially found that 3D printing technology can play an important role in the treatment of diseases in hepatopancreatobiliary surgery. For example, 3D printing technology has been applied to create detailed anatomical models of disease organs for preoperative personalized surgical strategies, surgical simulation, intraoperative navigation, medical training, and patient education. Moreover, cancer models have been created using 3D printing technology for the research and selection of chemotherapy drugs. With the aim to clarify the development and application of 3D printing technology in hepatopancreatobiliary surgery, we introduce seven common types of 3D printing technology and review the status of research and application of 3D printing technology in the field of hepatopancreatobiliary surgery.

The utility of three-dimensional modeling and printing in pediatric surgical patient and family education: a systematic review

BackgroundThree-dimensional (3D) modeling and printing are increasingly being used in surgical settings. This technology has several applications including pre-operative surgical planning, inter-team communication, and patient education and counseling. The majority of research on 3D technology has focused on adult populations, where it has been found to be a useful tool for educating patients across various surgical specialties. There is a dearth, however, of research on the utility of 3D modeling and printing for patient and family education in pediatric populations. Our objective was to systematically review the current literature on how this modality is being utilized in pediatric surgical settings for patient and family education and counselling.MethodsWe conducted a systematic review in accordance with PRISMA and CASP guidelines. The MEDLINE, CINAHL, Embase, and Web of Science databases were searched from inception to October 21, 2023, with no restrictions on language or geographical location. Citation chaining was used to ensure relevant papers were included. Articles were doubly screened and data was extracted independently by two authors. In the case of disagreement, a third author was consulted. Any articles pertaining to 3D modeling and printing in pediatric surgical settings for patient and family education and counseling were included.ResultsSix articles met inclusion criteria and were used for qualitative analysis. Two involved questionnaires given to parents of children to assess their understanding of relevant anatomy, surgical procedure, and risks after viewing conventional CT images and again after viewing a 3D-printed model. One involved a quasi-experimental study to assess young patients’ pre-operative surgical understanding and anxiety after undergoing conventional teaching as compared to after viewing a 3D storybook. One involved questionnaires given to parents of children in control and study groups to assess the usefulness of 3D printed models compared to conventional CT images in their understanding of relevant anatomy and the surgical procedure. Another study looked at the usefulness of 3D printed models compared to 2D and 3D CT images in providing caregiver understanding during the pre-operative consent process. The last article involved studying the impact of using 3D printing to help patients understand their disease and participate in decision-making processes during surgical consultations. In all six studies, utilizing 3D technology improved transfer of information between surgical team members and their patients and families.ConclusionOur systematic review suggests that 3D modeling and printing is a useful tool for patient and family education and counselling in pediatric surgical populations. Given the very small number of published studies, further research is needed to better define the utility of this technology in pediatric settings.

Preoperative Patient Education: Perceptions and Actual Practice among Nurses Working in Surgical Units.

Preoperative education is an essential nursing task that can be affected by the nurses' perception. Patients may be receiving insufficient vital information before surgery. However, the essential information that should be provided to patients undergoing surgery is not fully addressed. To assess the essential elements of preoperative information as perceived by the surgical nurses. This was a cross-sectional study. A convenience sample of 224 registered nurses who were working at surgical units was recruited from two hospitals. A preoperative teaching questionnaire was used. Details about the operation (4.39 ± 0.61) and preoperative preparation (4.36 ± 0.61) were the most important domains of preoperative education as perceived by nurses. The results show significant differences between the perceived and actual preoperative educational practice across all domains except the preoperative preparation. The delivery of preoperative education could be affected by nurses' perceptions. Efforts to facilitate the implementation of effective education as perceived by nurses should be conducted by minimizing potential barriers.

Optimizing Recovery After Carpal Tunnel Syndrome Release Surgery: The Role of Counseling in Pain Management and Perioperative Functional Enhancement.

Preoperative patient education is pivotal in improving patient outcomes during the perioperative phase, involving a thorough explanation of what patients can expect. This enhances adherence and reduces perioperative anxiety. In orthopedics, carpal tunnel syndrome, a common and painful hand condition, is effectively managed through surgical release under local anesthesia. Inadequate counseling before such procedures may intensify intraoperative anxiety and increase pain responses. Thus, this research aims to investigate the effects of comprehensive preoperative counseling on various parameters in carpal tunnel release surgery. A case-control study design was adopted for this study. A retrospective analysis of patients who underwent carpal tunnel release surgery was performed. These patients were categorized into two distinct groups: one group received comprehensive counseling during their clinic visits, while the other group reported receiving less effective counseling. Evaluation encompassed patient-related factors, disease-related aspects, and perioperative variables for both groups. The study comprised 681 participants, with 526 (77.2%) being females, 421 (61.8%) undergoing surgery on the right side, and 519 (76.2%) employed in non-manual occupations. Moreover, 559 (82.1%) were non-smokers, while approximately two-thirds of the cohort had both diabetes and hypertension. The average age of participants was 52 years, and they reported a mean functional disability score of 7.2 out of 10. The comprehensive preoperative counseling group consisted of 333 patients, while the other group included 348 patients. The analysis revealed statistically significant differences between the two groups, including reduced intra-procedural anxiety (p = 0.043), decreased intraoperative pain (p = 0.005), lower rates of wound complications (p = 0.022), and improved self-reported pain relief (p = 0.3). Our study emphasizes the crucial role of preoperative counseling in improving patient experiences during perioperative care, leading to reduced anxiety, milder pain responses, fewer complications, decreased reliance on postoperative pain medication, and increased self-reported pain relief. Level III, Case-control retrospective study.

Preoperative education in patients undergoing foot and ankle surgery: a scoping review

BackgroundInternational guidelines promote preoperative education for patients undergoing orthopedic surgery. However, the evidence sustaining these recommendations comes mainly from studies for hip and knee replacement surgery. Little is known about patients undergoing foot and ankle surgery. We aimed to map and characterize all the available evidence on preoperative education for patients undergoing foot and ankle surgery.MethodsThis study complies with the PRISMA-ScR guidelines. We searched eight databases, including MEDLINE, Embase, and CENTRAL. We performed cross-citations and revised the references of included studies. We included studies addressing preoperative education in patients undergoing foot and ankle surgery. We did not exclude studies because of the way of delivering education, the agent that provided it, or the content of the preoperative education addressed in the study. Two independent authors screened the articles and extracted the data. The aggregated data are presented in descriptive tables.ResultsOf 1596 retrieved records, only 15 fulfilled the inclusion criteria. Four addressed preoperative education on patients undergoing foot and ankle surgery and the remaining 11 addressed a broader population, including patients undergoing foot and ankle surgery but did not provide separate data of them. Two studies reported that preoperative education decreases the length of stay of these patients, another reported that education increased the knowledge of the participants, and the other leaflets were well received by patients.ConclusionThis scoping review demonstrates that evidence on preoperative education in foot and ankle surgery is scarce. The available evidence supports the implementation of preoperative education in patients undergoing foot and ankle surgery for now. The best method of education and the real impact of this education remain to be determined.

Effect of preoperative patient education and simulated mouth breathing training on opioid requirements in the post-anesthesia care unit after nasal surgery: a randomized controlled study

BackgroundA simulated education, prior to surgery about postoperative nasal stuffiness and ease of breathing through the mouth may help patients tolerate discomfort after nasal surgery. This study aimed to investigate the effect of preoperative simulated education on immediate postoperative opioid requirements in patients undergoing elective nasal surgery.MethodsThis randomized controlled trial of 110 patients undergoing nasal surgery randomly allocated patients into either a control (group C) or an education group (group E). One day before surgery, patients in group E were intensively trained to breathe through the mouth by using a nasal clip, with informative explanations about inevitable nasal obstruction and discomfort following surgery. Patients in group C were provided with routine preoperative information. Total intravenous anesthesia (TIVA) with propofol and remifentanil was used for anesthesia. No further opioid was used for analgesia intraoperatively. The primary outcome was index opioid (fentanyl) requirements at the post-anesthesia recovery unit (PACU). Secondary outcomes were emergence agitation, pain scores at the PACU, and postoperative recovery using the Quality of Recovery-15 (QoR15-K).ResultsThe rate of opioid use in the PACU was 51.0% in the group E and 39.6% in the group C (p = 0.242). Additional request for analgesics other than index opioid was not different between the groups. Emergence agitation, postoperative pain severity, and QoR15-K scores were comparable between the groups.ConclusionPreoperative education with simulated mouth breathing in patients undergoing nasal surgery did not reduce opioid requirements.Trial registrationKCT0006264; 16/09/2021; Clinical Research Information Services (https://cris.nih.go.kr).

Enhanced Recovery After Surgery: Exploring the Advances and Strategies.

Enhanced recovery after surgery (ERAS) has emerged as a paradigm-shifting approach in perioperative care, aimed at optimizing patient outcomes, accelerating recovery, and minimizing hospital stays. This review delves into the latest advances and strategies within the field of ERAS, encompassing a comprehensive examination of preoperative, intraoperative, and postoperative interventions. By analyzing an array of clinical studies, meta-analyses, and implementation experiences, this review highlights the multifaceted elements contributing to the success of ERAS programs. Key components such as preoperative patient education, minimally invasive surgical techniques, tailored anesthesia protocols, judicious fluid management, optimized pain control, early ambulation, and structured nutritional support are thoroughly explored. Furthermore, the review delves into the intricacies of ERAS implementation across diverse surgical specialties, emphasizing the significance of multidisciplinary collaboration, protocol customization, and sustained quality improvement initiatives. The analysis not only showcases the tangible benefits of ERAS, including reduced complication rates, shortened hospital stays, and enhanced patient satisfaction, but also underscores the challenges and barriers that medical professionals encounter during program adoption. By synthesizing the current state of ERAS research and practice, this review provides clinicians, administrators, and researchers with valuable insights into the evolving landscape of perioperative care, fostering a deeper understanding of ERAS as a holistic approach that transcends traditional surgical pathways.

Hotline to Helpline: Reducing On-call Demands.

There is a growing societal trend in plastic surgery patients of viewing their medical care as a commodity product rather than as a healthcare service. Our four-provider private plastic surgery practice noticed this phenomenon through our patients' trend of overusing the emergency after-hours service call line. To affect this behavior, we designed a study educating patients on the emergency service call line's purpose and how to handle nonurgent issues independently. After a 6-month preintervention phase to categorize after-hours emergency calls, We improved preoperative patient education and implemented in-office protocols for quicker provider responses. Postintervention data were collected for another 6 months and compared statistically with the preintervention data. In the preinterventional period, we saw a total of 236 after-hours phone calls. The intervention led to a 22% significant reduction in total calls (P = 0.007). Calls were categorized as nonurgent, urgent, and emergent. While emergent calls remained unchanged (P = 0.56), nonurgent calls significantly decreased (P = 0.005). The most common nonurgent calls were regarding pain, routine postoperative concerns, and drain care, with the intervention resulting in a significant reduction of routine postoperative swelling/bruising/discomfort calls (P = 0.04) but not changing pain (P = 0.23) or drain-related calls (P = 0.78). We found that targeted preoperative patient education coupled with a real-time action board in the office, to ensure timely response to patient questions during office hours, can positively impact after-hours call use, and improve overall patient outcomes by catching urgent issues earlier.

Enhanced recovery protocols for ambulatory surgery.

In the United States, ambulatory surgeries account for up to 87% of all surgical procedures. (1) It was estimated that 19.2 million ambulatory surgeries were performed in 2018 (https://www.hcup-us.ahrq.gov/reports/statbriefs/sb287-Ambulatory-Surgery-Overview-2019.pdf). Cataract procedures and musculoskeletal surgeries are the most common surgical interventions performed in ambulatory centers. However, more complex surgical interventions, such as sleeve gastrectomies, oncological, and spine surgeries, and even arthroplasties are routinely performed as day cases or in a model of an ambulatory extended recovery. (2-5) The ambulatory surgery centers industry has grown since 2017 by 1.1% per year and reached a market size of $31.2 billion. According to the Ambulatory Surgery Center Association, there is a potential to save $57.6 billion in Medicare costs over the next decade (https://www.ibisworld.com/industry-statistics/market-size/ambulatory-surgery-centers-united-states/). These data suggest an expected rise in the volume of ambulatory (same day) or extended ambulatory (23h) surgeries in coming years. Similar increases are also observed in other countries. For example, 75% of elective surgeries are performed as same-day surgery in the United Kingdom. (6) To reduce costs and improve the quality of care after those more complex procedures, ambulatory surgery centers have started implementing patient-centered, high-quality, value-based practices. To achieve those goals, Enhanced Recovery After Surgery (ERAS) protocols have been implemented to reduce the length of stay, decrease costs, increase patients' satisfaction, and transform clinical practices. The ERAS fundamentals for ambulatory surgery are based on five pillars, including (1) preoperative patient counseling, education, and optimization; (2) multimodal and opioid-sparing analgesia; (3) nausea and vomiting, wound infection, and venous thromboembolism prophylaxis; (4) maintenance of euvolemia; and (5) encouragement of early mobility. Those pillars rely on interdisciplinary teamwork led by anesthesiologists, surgery-specific workgroups, and safety culture. (2) Research shows that a team of ambulatory anesthesiologists is crucial in improving postoperative nausea and vomiting (PONV) and pain control. (7) This review will summarize the current evidence on the elements and clinical importance of implementing ERAS protocol for ambulatory surgery.

Risk factors of liposomal bupivacaine failure in managing postoperative pain following shoulder surgery

BackgroundAmidst a national opioid crisis, increased focus has been placed on reducing opioid consumption. Novel multimodal pain protocols including the use of liposomal bupivacaine (LB) have shown success in minimizing opioid usage after orthopedic surgery. There is disputing evidence of the effectiveness of LB use in shoulder surgery and the purpose of our study was to analyze the risk factors and determinants of LB failure for postoperative pain control after orthopedic shoulder surgeries. MethodsA retrospective review of 121 patients undergoing shoulder surgery treated by 2 fellowship-trained shoulder surgeons at a single institution was performed from 2018-2020. All patients received a standardized multimodal pain management protocol that included an LB interscalene block. Local infiltration of LB was also administered at closure. Visual analog scales (VASs) were administered at 24, 48, 72 hours, and 7 days postoperatively. LB failure was defined as visual analog scale score >7 any time within the 7-day postoperative period. Twenty-one patients were included in the liposomal bupivacaine failure (LBF) group and 100 in the liposomal bupivacaine success (LBS) group. Patient demographics, pain scores, and opioid consumption were compared between groups. ResultsBaseline characteristics were comparable, except the LBF cohort had a greater proportion of females (P = .03). The LBF group had 20% of patients with a history of chronic opioid use compared to none in the LBS group (P = .003). Logistic regression showed strong and independent associations between failure of LB and performing surgeon, chronic opioid use, gender, and history of prior surgery. Patients in the LBF group had an average of 20 total morphine equivalents 7-14 days following surgery compared to 0 total morphine equivalents (P = .002) in the LBS group, and an average of 2.9 opioid prescriptions within the first 6 months compared to 1.7 in the LBS group (P = .028). ConclusionPerforming surgeon, gender, history of opioid use, and prior surgeries were all identified as strong, independent predictor variables of LB failure. In this study, performing surgeon is likely indicative of the impact of differences in patient education on postoperative pain expectations and alternate treatments. We recommend that surgeons incorporate further preoperative patient education, and to take into account, the specific risk factors when deciding to incorporate LB into their multimodal postoperative pain management plan for patients undergoing shoulder surgery.

Can robotic-assisted surgery support enhanced recovery programs?

Enhanced recovery after surgery (ERAS) protocols comprise a multimodal approach to optimize patient outcome and recovery. ERAS guidelines recommend minimally invasive surgery (MIS) when possible. Key components in MIS include preoperative patient education and optimization; multimodal and narcotic-sparing analgesia; prophylactic measures regarding nausea, infection, and venous thrombosis; maintenance of euvolemia; and promotion of the early activity. ERAS protocols in MIS improve outcome mainly in terms of reduced length of stay and subsequently reduced cost. In addition, ERAS protocols in MIS reduce postoperative pain and nausea, increase patient satisfaction, and might reduce the rate of postoperative complications. Robotic surgery supports ERAS through facilitating MIS in complex procedures where laparotomy is an alternative approach.

Levels of Surgical Patients' Education Related to Surgical Interventions Among Patients in Saudi Arabia.

Patient education and counseling should simplify and clarify the condition, surgery, postoperative care, and potential complications. This study aimed to determine the levels of surgical patients' education regarding surgical interventions among patients inSaudi Arabia. This was an online survey study that was conducted between January and May 2023 to determine the levels of surgical patients' education regarding surgical interventions among patients in Saudi Arabia. The study population was patients who underwent surgeries (elective and emergency) living in Saudi Arabia. The questionnaire tool used in this study was developed based on an extensive literature review in the field of patients' education regarding surgical interventions. Binary logistic regression analysis was used to identify predictors of satisfaction with the calloutsand the surgeon-consultant's communication quality. A total of 1360 participants were involved in this study. Around40.5% of the participants reported thatthey met the surgeonafter diagnosing and recommending the issue. Almost 70.0% of research participants reported that the consultant surgeon personally explained a diagnosis or strategy to attain it and the surgical technique, method, and purpose before signing the informed consent.The majority of study participants reported that the consulting surgeon or a member of his surgical team explained the stages of reaching a diagnosis and the steps he/she will take to diagnose their condition (83.2%), discussed the diagnosis with themand how certain they are of the diagnosis (88.1%), described the surgery clearly and simply (85.5%), informed them of alternatives to surgical intervention (63.1%), and discussed the entire postoperative treatment plan (81.8%), informed them of possible postoperative complications (79.6%), used additional callout during the discussion (81.3%), and spoketo them after the surgery and before they left the hospital (69.2%).After a conversation with their doctors, 36.3% of study participants said they did not require an outside source to understand the diagnosis, operation, probable problems, treatment plan, and follow-up. Discussion"Just talk," sketching, and pictograms were the most popular callouts during patient education, with 78.3%, 22.3%, and 17.9%, respectively. Saudi participants were more likely to be satisfied with the quality of communication by the surgeon-consultant (p<0.05). At the same time, participants who live in the Southern area were less likely to be satisfied with the quality of communication by the surgeon-consultant (p<0.05). This study highlights the crucial role of surgeons in preoperative patient education as well as the significance of surgical team participation in this process. In order to increase patient knowledge, facilitate treatment decisions, and assure informed consent, it is necessary to establish guidelines and roles to improve surgeon-patient communication, increase patient and surgeon awareness, nurture patient concern expression, and encourage non-medical patient participation.