Preoperative Preparation Of Patients Research Articles

The efficacy of pre-operative preparation with intravenous iron and/or erythropoietin in anaemic patients undergoing orthopaedic surgery: An observational study.

Pre-operative anaemia and transfusion are common among patients undergoing elective orthopaedic surgery. Application of 'patient blood management' might be the most effective way to reduce both anaemia and transfusion. Pre-operative administration of iron and/or erythropoietin (EPO) is one of the cornerstones of the first pillar of patient blood management, but in a daily clinical setting, efficacy and long-term safety of this measure have not been analysed thoroughly to date. To investigate the influence of pre-operative preparation (PREP) of patients with iron and/or EPO on peri-operative transfusion needs and long-term survival. Single-centre, retrospective study. Anaesthesia department, University hospital. Pre-operative preparation with iron and/or EPO versus no preparation. After approval of our local ethics committee, data of 5518 patients who received total hip or total knee replacement between 2008 and 2014 were included. Patients receiving iron and/or EPO were included in the PREP group, whereas patients without iron and/or EPO were included in the no preparation group. From the full data set, a bias-reduced subset of 662 patients was obtained by means of propensity score-matching to compare peri-operative red blood cell utilisation and long-term survival of patients between groups. Patients in the PREP group needed a lower number of units of red blood cells than patients in the no preparation group (0.2 ± 0.8 vs. 0.5 ± 1.3, P < 0.001), had a lower transfusion rate (12 vs. 24%, P < 0.05) and had a similar haemoglobin concentration (10.7 ± 1.3 vs. 10.6 ± 1.1 g dl, not significant) at discharge. No differences in long-term survival were observed between the two study groups. PREP of patients with iron and/or EPO in orthopaedic patients can be considered highly effective in terms of transfusion reduction, without influencing long-term survival.

BRIDGING THERAPY RESULTS IN PATIENTS WITH ACUTE CALCULOUS CHOLECYSTITIS AND CONCOMITANT ISCHEMIC HEART DISEASE

Introduction. Binding or bridging therapy (BT) suggests long-term administration of short acting anticoagulants (unfractionated heparin – UFH or low-molecular-weight heparin – LMWH) during preoperative preparation and early postoperative period in patients who had been receiving anticoagulation therapy (ACT) or anti-aggregation therapy (AAT) for a long time before surgery. The generalized data on the BT technique for urgent surgical interventions, particularly, in patients with acute calculous cholecystitis (ACH) and concomitant ischemic heart disease (IHD), is currently lacking. The aim of the work – to improve the BT technique in patients with ACH and IHD and to evaluate the results of its application.&#x0D; Materials and methods. The study included 73 patients– 33 (45,2 %) women and 40 (54,8 %) men aged 57 to 81 years, on average 71,4 ± 0,7 years, who had received ACT or AAT before the hospitalization. All patients were admitted to hospital within 72 hours (from 6 to 65 hours) from the onset of the disease, on average 27.3 ± 1.5 hours. The catarrhal ACH occurred in 27 (37,0%) patients, phlegmonous – in 21 (28,8 %) patients, gangrenous – in 25 (34,2 %) patients. According to Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG13), 19 (26.0 %) patients had ACH I degree, 31 (42.5 %) patients– ACH II degree, 23 (31.5 %) patients – ACH III degree. There were 3 (4.1 %) patients with NYHA class I heart failure, 39 (53.4 %) patients with NYHA class II heart failure, 26 (35.6 %) patients with NYHA class III heart failure, and 5 (6.8 %) patients with NYHA class IV heart failure. The advanced tactics of bridging therapy was applied, which depended on several factors such as INR, aPTT, creatinine clearance, Lee-White’s bleeding time. The target points were the frequency of INR or bleeding time therapeutic range achieving, and the frequency of hemorrhagic complications.&#x0D; Results and discussion. Immediately before surgery (laparoscopic cholecystectomy), the target (therapeutic) INR range &gt;2 was obtained in 18 (90 %) patients among 20 patients who had previously received warfarin. Among them 2 (10.0 %) patients had INR in the range of 1.3-2.0, 12 (60.0%) patients had INR in the range of 2.1-3.0, and 6 (30.0 %) had INR &gt;3.1. The target value of bleeding time &gt;12 min was in 48 (90.6 %) patients among the patients (53 patients) who had received AAT earlier. The values of bleeding time in the range of 10-12 min were in 5 (9.4 %) patients, 12.1-14 min –in 42 (79.2 %) patients, &gt;14 min – in 6 (11.3 %) patients. In general, INR and bleeding time values were within the therapeutic window in 65 (90.3 %) patients, and there was no patient with signs of hypercoagulation. In the postoperative period, the dynamics of INR and bleeding time values were similar and figured out at increase in the part of patients with INR 2.1-3.0 and bleeding time 12.1-14 min respectively.

Application of silicone implants in mammoplasty (literature survey)

In the article literature data concerning indications to placement of silicone breast implants in plastic surgery are presented. Peculiarities of preoperative preparation of patients aimed at prevention of postoperative complications are considered. The technique of surgical intervention, advantages and disadvantages of different methods are described. Difference in choice of surgical approach and positioning of implant relative to mammary gland are considered. Recommendations are given on selection of the type of implant, on determination of the volume of supposed silicone breast-implant prostheses, and also on the choice of optimal access for their insertion. The early and long-term complications and measures proposed by the authors for their elimination are studied. According to different studies, the commonest complication of the augmentation mammoplasty is contracture of the fibrous capsule surrounding the implant that requires surgical correction. One of main complications of all kinds of augmentation mammoplasty is secondary ptosis of mammary gland. A common complication of the augmentation mammoplasty is incorrect position of implants such as their asymmetry and location on different levels. In case of tubular breast a double inframammary fold may result unless tubularity of areola is corrected. Authors think that a significant number of unsolved problems concerning augmentation mammoplasty, optimal surgical approach, existence of the immediate and long-term complications are reasons for further study of augmentation mammoplasty. Increased dissatisfaction of patients with long-term results of augmentation mammoplasty, necessity to prevent such complication as fibrous contracture, create an urgent need for search of new methods. Thus, application of silicone implants in augmentation mammoplasty requires further study with the aim of optimization of the final aesthetic and clinical result.

Application of silicone implants in mammoplasty (literature survey)

In the article literature data concerning indications to placement of silicone breast implants in plastic surgery are presented. Peculiarities of preoperative preparation of patients aimed at prevention of postoperative complications are considered. The technique of surgical intervention, advantages and disadvantages of different methods are described. Difference in choice of surgical approach and positioning of implant relative to mammary gland are considered. Recommendations are given on selection of the type of implant, on determination of the volume of supposed silicone breast-implant prostheses, and also on the choice of optimal access for their insertion. The early and long-term complications and measures proposed by the authors for their elimination are studied. According to different studies, the commonest complication of the augmentation mammoplasty is contracture of the fibrous capsule surrounding the implant that requires surgical correction. One of main complications of all kinds of augmentation mammoplasty is secondary ptosis of mammary gland. A common complication of the augmentation mammoplasty is incorrect position of implants such as their asymmetry and location on different levels. In case of tubular breast a double inframammary fold may result unless tubularity of areola is corrected. Authors think that a significant number of unsolved problems concerning augmentation mammoplasty, optimal surgical approach, existence of the immediate and long-term complications are reasons for further study of augmentation mammoplasty. Increased dissatisfaction of patients with long-term results of augmentation mammoplasty, necessity to prevent such complication as fibrous contracture, create an urgent need for search of new methods. Thus, application of silicone implants in augmentation mammoplasty requires further study with the aim of optimization of the final aesthetic and clinical result.

STENOSIS OF THE CELIAC TRUNK – FROM DIAGNOSTICS TO TREATMENT

Compression stenosis of the celiac trunk (CSCT) is a syndrome based on the celiac trunk stenosis of varying degree, sometimes in combination with that of the superior mesenteric artery, caused by the compression of this vessel by the medial arched ligament of the diaphragm, as well as its internal legs and the neurofibrotic tissue of the celiac plexus. CSCT can cause chronic ischemia of the abdominal organs and chronic pain syndrome. The branches of the celiac trunk, supplying the stomach, liver, pancreas to the blood, are connected with the mesenteric arteries of the intestine in a common circle, therefore, with a lack of blood flow along one of the branches, the entire digestive tract suffers . The main clinical manifestation of CSCT is abdominal pain, observed in 97–100% patients. Angiography is the most invasive and, at the same time, the most informative method currently available to assess the extent and degree of the celiac trunk narrowing and to determine indications for surgical treatment. Ultrasound is a harmless, painless and at the same time informative diagnostic method for CSCT. A modern ultrasound technique is ultrasound with the use of echocontrast. Multi-detector CT angiography with multiplanar and 3D reconstruction is the optimal method of X-ray diagnostics of CSCT. MR angiography is successfully used both for preoperative preparation in patients with compression of the celiac trunk, and in the postoperative period. The methods of surgical treatment for abdominal ischemia are divided into palliative, decompressional and reconstructive. Modern diagnostic methods allow non-invasive methods to diagnose CSES in combination with clinical manifestations. The laparoscopic method is optimal for celiac trunk decompression, but the choice of the surgical treatment method should be considered individually.

An update on preoperative assessment and preparation of surgical patients with obstructive sleep apnea.

There is a high prevalence of obstructive sleep apnea (OSA) in the surgical population, however, a significant proportion of patients are undiagnosed. The Society of Anesthesia and Sleep Medicine (SASM) has issued recent guidelines for preoperative assessment and preparation of patients with known or suspected OSA. The purpose of this review is to highlight key points in the new guidelines and explore the possibilities of different strategies in optimizing patients with OSA preoperatively. Recent knowledge on phenotypes and endotypes has provided a better understanding of the disease and its underlying pathogenesis. Phenotypes refer to the predominant morphological characteristics of an individual whereas endotypes refer to the predominant underlying mechanism of the disease. Phenotypes and endotypes in OSA are heterogenous. Heterogeneity in the pathogenic mechanisms implies that opportunities other than the use of continuous positive airway pressure (CPAP) may exist to optimize or manage OSA patients preoperatively. The prevalence of OSA in surgical patients is high. SASM has made recommendations in their published guidelines for the optimum preoperative preparation of patients with OSA. In the future, research may shift towards finding the underlying mechanism of OSA for targeted therapy.

Perioperative complications after surgical treatment in degenerative adult de novo scoliosis

BackgroundDegenerative adult de novo (DAD) scoliosis appears characteristically in the sixth or seventh decade with symptoms of severe back pain and radiculopathy or spinal claudication. The aim of this study was to enhance the knowledge of perioperative complications and detect possible risk factors in this selective DAD scoliosis surgery.MethodsThis retrospective study included only patients with DAD scoliosis undergone correction spondylodesis with previous failure of conservative treatment. Excluded were patients with other types of scoliosis and previous fusion surgeries. Patient epidemiological data, medical comorbidities and treatments were included. Intraoperative data and perioperative complications were documented. Analyses regarding early, late and no complications were undertaken.ResultsA total of 92 patients with a mean age of 67.29 ± 7.93 years and clinical follow-up visits of minimum 12 months were included. On average, 5.26 ± 2.24 segments were fused. Early complications (e.g. wound healing defects, paresis, screw loosing) occurred in 23 patients and often required a re-operation. Cardiac arrhythmias, pacemaker and coumarin derivative therapies were associated with increased perioperative complications. The transforaminal lumbar interbody fusion technique was associated with early complications. Adjacent segment failure occurred in 36% and was the major late complication. Twenty patients did not have any complications in the minimum follow-up.ConclusionsThis study analysed a selective DAD scoliosis collective and its’ surgical treatment outcomes. It identified numerous perioperative complications (adjacent segment failure, postoperative paresis and epidural hematoma) and multiple possible predisposing risk factors (e.g. operative techniques and anti-coagulation therapies). This here gained information raises awareness in preoperative patient selection and preparation. Further studies in DAD scoliosis and a risk-adjusted patient selection/preparation are needed to improve treatment quality and outcomes.

Race, Bundled Payment Policy, and Discharge Destination After TKA: The Experience of an Urban Academic Hospital.

Background:Total knee arthroplasty (TKA) provides good clinical outcomes for the treatment of end-stage osteoarthritis; however, discharge destination after TKA has major implications on postoperative adverse outcomes and readmissions. With the initiation of Bundled Payments for Care Improvement (BPCI), it is unclear how racial disparities in discharge destination after TKA will be affected by the new bundled payment for TKA.Methods:Bundled Payments for Care Improvement was implemented in July 01, 2014, at the University of Pennsylvania. We compared differences during early implementation (July 1, 2014, to, March 30, 2016) and during late policy implementation (April 1, 2016, to February 28, 2017) in patient characteristics (including race: African American [AA], white, and other race), discharge destination (skilled nursing facility [SNF], inpatient rehabilitation facility, home, home with home health, or other), and outcomes.Results:We identified 2276 patients who underwent TKA (43.8% AA, 48.2% white, and 8.0% other race). African American patients were more likely to be discharged to SNF as opposed to home than white patients both during the early BPCI (AA: 53.0%, n = 320; white: 32.4%, n = 210, P < .05) and late BPCI implementation (AA: 44.4%, n = 169, white: 26.9%, n = 120, P < .05), though all races showed trends to decreasing SNF use during the late BPCI implementation.Discussion:There were no significant differences in readmissions, length of stay, mortality, or intensive care unit days during early and late implementation of BPCI or when AA patients were compared to white patients.Conclusion:We found no significant changes in racial variations in discharge destination and outcomes after elective TKA. Bundled Payments for Care Improvement has encouraged better preoperative preparation of patients and discharge planning; however, payment reforms alone might not be sufficient to address variation in post-op management following elective surgery.

Ameliyat Öncesi Dönem Hasta Hazırlığında Hemşirelik Yönetimi

Cerrahi yöntemler belirli sorunları çözümlerken uygun izlem/girişimlerde bulunulmadığında yeni sorunlar yaratarak yaşamı tehdit edici olabilmektedir. Günümüzde cerrahi tekniklerin ve anestetiklerin gelişimi cerrahi süreci etkilemiştir. Hastalar cerrahi girişim günü hastaneye yatmakta ve aynı gün taburcu olarak hastanede daha az zaman geçirmektedir. Bu durum hemşire ve hasta etkileşimini azaltmış, cerrahi hemşirelerinin rolleri de zaman içinde değişikliğe uğramıştır. Ameliyat öncesi değerlendirmede kısa sürede nitelikli ve güvenli bakımı sürdürebilmek için kanıta dayalı standart yaklaşımları içeren bireyselleştirilmiş bakımın verilmesi gerekmektedir. Birey ve aile, yaşamı tehdit edici riskler taşıyan cerrahi girişimi beklerken, bilinmeyen/olabilecek pek çok şeyden korkmakta ve yüksek düzeyde anksiyete yaşamaktadır. Ameliyat öncesi gereksinimleri uygun şekilde karşılanan hasta cerrahi travmayla daha iyi baş edebilmekte, komplikasyon riski azaltılarak daha kısa sürede iyileşmekte ve dolayısıyla morbitide/mortalite azaltılmaktadır. Bu çalışmada, güncel literatür gözden geçirilerek hastaların ameliyat öncesi psikolojik/fizyolojik hazırlığına, ameliyat öncesi eğitime, ameliyat öncesi gece hazırlığı ve ameliyat günü hazırlığına odaklanılması amaçlanmıştır.

The Role of Preoperative Evaluations in Otorhinolaryngological Procedures.

Background:Routine laboratory investigations are important in preoperative preparation of otorhinolaryngological, head and neck patients to assess and to prevent operative risks. This study aimed at determining the American Society of Anesthesiologist (ASA) classification of the preoperative patients, causes of delayed surgery, associated comorbidity and abnormal laboratory investigation results in ear, nose, and throat surgical practice in a low-resource setting.Materials and Methods:This is a prospective hospital-based study of patients being worked up for elective surgical procedures in Ekiti State University Teaching Hospital, Nigeria, from January 2014 to December 2016. Patients that gave consent were enrolled into the study. Interviewer-assisted questionnaires were used to obtained data from the patients. Data obtained were collated and statistically analyzed by using SPSS version 16.Results:A total of 424 patients were enrolled into the study. Males constituted 61.8% and male to female ratio was 2:1. Majority, i.e. 69.8% of the patients belonged to the ASA Grade I. Preoperative findings leading to delayed surgery occurred in 17.9% of the patients. They were due to 2.4% arterial hypertension and 6.4% delayed routine laboratory investigations results. The overall comorbid illness was 21.2%. Major comorbid illnesses were 2.4% arterial hypertension and 6.8% diabetes mellitus. The types of surgery in the patients were 14.6% ear surgery, 12.3% nasal surgery, and 59.2% throat surgery. Delayed surgery occurred in 25.5% of the patients. The most common findings were 6.8% anemia, 6.3% abnormal prothrombin/international normalized ratio, and 5.7% blood electrolyte and urea.Conclusion:All surgical conditions are peculiar with different comorbid illnesses which can lead to untoward outcome. Adequate preoperative evaluation and preoperative laboratory investigation of ear, nose, and throat conditions are mandatory to detect subclinical illnesses in poor-resource setting.

Features of anesthesiological management for transnasal surgical in pituitary adenomas: literature review

Tumors of the pituitary gland make up about 10% of all neoplasms of the brain, mainly represented by adenomas. A feature of a larger number of adenomas is the symptoms of hypersecretion of the pituitary hormones, which leads to typical changes in the patient’s body. Surgical removal of pituitary tumors is performed through endoscopical transnasal access. Understanding the individualities of patients, the disease course and the operation course helps the anesthesiologist to ensure adequate preoperative preparation, anesthesia and postoperative management for patients, which reduces the number of complications and facilitates the early recovery of patients.

PROADRENOMEDULIN AS A PREDICTOR OF MORTALITY IN MAJOR NON-CARDIAC SURGERY

Anesthesiologists are in daily contact with patients who are preparing for noncardiosurgical interventions, and who have an increased risk of developing cardiovascular complications in the perioperative period. Less than 1% of patients develop perioperative IM, however the mortality rate for this complication ranges from 30% to 50%. The first step is the identification of patients in whom the cardiovascular system is a potential source of complications during and after surgery. The risk of perioperative complications depends on the condition of the patient prior to the intervention, prevalence of comorbidities and the extent, urgency and duration of the operation. The modern concept of preoperative preparation of patients for major non-cardiac surgery is now based on the measurement and interpretation of various biomarkers as prognosticators of perioperative cardiovascular complications and fatal outcomes. For these purposes, high-performance natriuretic peptides and cardiac troponins are used. There is evidence that the levels of cardiac-specific troponins, and especially highsensitivity troponin T(hs-TnT), have been elevated in patients with various cardiovascular diseases such as: cardiac insufficiency and coronary disease, reflecting in this way a lower degree of damage that can be of significant benefit in the preoperative assessment of cardiovascular morbidity and mortality in elective, major non-cardiac surgery. Although various natriuretic peptides have been in the greatest focus of interest as prognostic biomarkers over the past decade, the interest in other circulating biomarkers, such as midregional proadrenomedulin (MR-pro ADM), has been growing in recent years. This new biomarker represents a stable circulating peptide, and is the prohormone of adrenomedulin, a hormone responsible for regulating the volume of circulating fluid and electrolyte homeostasis. Elevated levels of this biomarker are seen in heart failure of different etiologies and can therefore serve as a useful prognostic marker of the development of perioperative cardiovascular complications in patients with different cardiovascular comorbid conditions.

WAY OF PREOPERATIVE PREPARATION FOR PATIENTS WITH CHRONIC ANAL FISSURES

The use of intratissue electrophoresis with a dioksyzol solution as a preoperative preparation of patients with chronic anal fissures of the void causes reduction of the manifestation of hemodynamic disorder, acute inflammatory responses in tissues anal fissure and encourages the development of young granulation tissue in the area of the wound edges and the edge of the resection, contributes to the reduction of the intensity of the pain syndrome, reduces expression of inflammation, stimulates reparative processes in the area of the crack, accelerates epithelization and the healing of surgical wounds, quickly removes spasm of the sphincter and anal pain, tearing main pathogenetic mechanism of the disease.

A Standardized Preoperative Group Intervention Is Feasible and Acceptable to Orthognathic Surgery Patients

Nearly 10% of patients remain dissatisfied after orthognathic surgery, largely because of psychoeducational or psychosocial factors. The purpose of this study was to evaluate the feasibility and acceptability of a psychoeducationally based group intervention to improve preoperative preparation of orthognathic surgical patients and their caregivers. The intervention consisted of 2 group sessions, with each session lasting 2hours. The sessions provided realistic expectations of the surgery, offered teaching strategies for coping with pre- and postoperative symptoms of psychopathology, and highlighted the importance of social support. Feasibility was based on attendance, homework completion, and data collection rates, and acceptability was based on post-treatment participant satisfaction scores on the Client Satisfaction Questionnaire-8 (CSQ-8) and credibility and expectancy scores on 2 subscales of the Credibility/Expectancy Questionnaire-Modified (CEQ-M). Twenty-six orthognathic surgical patients were recruited from an outpatient oral and maxillofacial surgery clinic to attend the group-based intervention. Seventy percent of patients who attended at least 1 session completed the 2 sessions, and 64% of those who attended the 2 sessions completed at least 1 homework assignment. The authors successfully collected 84% of the total measures given to patients and their caregivers. The mean satisfaction rating of the patients was 30.12 of 32 (CSQ-8; n=13; standard deviation [SD], 2.33), the mean credibility rating of the patients and their caregivers was 25.2 of 27 (CEQ-M; n=20; SD, 1.85), and the mean expectancy rating of the patients and their caregivers was 20.54 of 27 (CEQ-M; n=20; SD, 4.39). The psychoeducationally based group intervention was feasible and acceptable for participants and their caregivers. This article offers suggestions to further improve the feasibility and acceptability of the intervention, including optimizing standardization of data collection procedures, decreasing barriers to access, and increasing participant engagement.

Preoperative Nutritional Optimization for Crohn’s Disease Patients Can Improve Surgical Outcome

Background: Preoperative preparation of patients with Crohn’s disease is challenging and there are no specific guidelines regarding nutritional support. The aim of this study was to assess whether preoperative nutritional support influenced the postoperative outcome. Methods: A retrospective, cohort study including all Crohn’s disease patients who underwent abdominal surgery between 2008 and 2014 was conducted. Patients’ characteristics and clinical and surgical data were recorded and analyzed. Results: Eighty-seven patients were included in the study. Thirty-seven patients (42.5%) received preoperative nutritional support (mean albumin level 3.14 vs. 3.5 mg/dL in the non-optimized group; p < 0.02) to optimize their nutritional status prior to surgery. Preoperative albumin level, after adequate nutritional preparation, was similar between the 2 groups. The 2 groups differ neither in demographic and surgical data, overall post-op complication (p = 0.85), Clavien-Dindo score (p = 0.42), and length of stay (p = 0.1). Readmission rate was higher in the non-optimized group (p = 0.047). Conclusion: Nutritional support can minimize postoperative complications in patients with low albumin levels. Nutritional status should be optimized in order to avoid hazardous complications.

Blood flow restriction training as a prehabilitation concept in total knee arthroplasty: A narrative review about current preoperative interventions and the potential impact of BFR

Osteoarthritis of the knee is one of the most commonly diagnosed joint ailments and responsible for increased rates of total knee arthroplasty surgeries worldwide. Whereas the surgical approach is able to diminish the perceived knee pain of concerned patients’, the postoperative recovery is often accompanied by persistent skeletal muscle dysfunctions and atrophy, which is responsible for functional deficits for up to several years. Recent findings indicate that surgery induced adverse effects on skeletal muscles are largely associated with the use of pneumatic tourniquets, wherefore several studies try to reduce tourniquet use in orthopedic surgery. However, due to comparable incidence of muscle impairment and increased surgical challenge, the most frequently applied surgical technique in TKA is still associated with the use of tourniquets. When attenuating TKA induced adverse effects, the preoperative preparation of patients by specific exercises (called prehabilitation) was able to enhance preoperative overall fitness through associated accelerated recovery. Based on patients’ limited functional activity, prehabilitation techniques have to be particularly designed to allow regular adherence. The present paper is based on a narrative review of current literature, and provides a novel hypothesis by which blood flow restriction exercises (BFR) are able to improve patients’ compliance to prehabilitation. BFR training is characterized by the application of low-resistance exercise with similar intensities as daily living tasks in association with a suppression of venous blood flow in an extremity, achieving significant morphological and neuromuscular adaptations in skeletal muscles. In addition, preoperative enhancements in muscle health with corresponding benefits in overall fitness, BFR induced molecular alterations could also be able to interfere with TKA induced pathological signaling. Therefore, based on the known major impact of BFR on skeletal muscle physiology, the present paper aims to illustrate the potential beneficial impact of BFR training as a prehabilitation concept to promote patients regular adherence to preoperative exercises and thus achieve an accelerated recovery and increases in patients’ satisfaction.

Weight Loss Before Complex Ventral Hernia Repair: Is It Sustainable?

Motivation of patients to lose weight is a principal concern in preoperative preparation of patients for complex ventral hernia repair (cVHR). Weight changes following cVHR, however, are not well characterized. In this study, we explored 3 questions: 1) is preoperative weight loss sustainable after operation, 2) can patients unable to lose weight preoperatively initiate weight loss after cVHR, and 3) are there clinical factors that predict postoperative weight change? We performed a retrospective medical record review of patients who underwent open cVHR at an academic tertiary referral center from January 2013 through August 2015. Exclusions were inflammatory bowel disease, metastatic cancer, and bariatric operation specifically in anticipation of cVHR. There were 112 patients included with the following profile: average age 58.4 ± 11.2 years, 84.8% with operative BMI ≥ 30 kg/m2, 29.5% Ventral Hernia Working Group Grade ≥ 3. Sixty-three (56.3%) patients lost weight preoperatively; of these, 57.1% had gained weight 1 year after cVHR. Forty-nine (43.0%) patients gained weight preoperatively; 42.9% of these lost weight postoperatively. No risk factors were identified that predict a high likelihood of pre- or postoperative weight loss. Despite success in promoting weight loss prior to surgery, a high rate of recidivism to weight gain occurs postoperatively. Further, in those patients unable to lose weight preoperatively, cVHR did prompt weight loss in a minority of patients. Together, these findings emphasize the importance of developing weight reduction programs for cVHR patients that not only optimize preoperative conditions but that are also sustainable.

Effects of nasal spray inhalation in preoperative preparation for patients with chronic sinusitis and nasal polyps

Objective To evaluate the method, efficacy and safety of nasal spray inhalation by applying nasal inhalation of budesonide suspension in preoperative preparation for patients with chronic sinusitis and nasal polyps. Methods Totally 25 hospitalized patients with chronic rhinosinusitis and nasal polyps were enrolled, who were given a dose of 1 mg/2 ml budesonide suspension by nasal spray inhalation twice a day for one week before surgery. Their symptoms were evaluated before and after treatment, with their Kennedy endoscopic score, morning serum glucocorticoid, surgical time and surgical bleeding measured. Results The patients showed lower scores in nasal symptoms and endoscopic polyps than they were at admission (P 0.05) ; the surgical time was (93.36 ± 14.43) min and the surgical bleeding score was level-5. Conclusions The application of budesonide suspension by nasal spray inhalation one week before surgery can improve nasal symptoms, reduce the volume of nasal polyps as well as surgical bleeding, thus it is a safe and effective method for preoperative preparation. Key words: Sinusitis; Nasal polyps; Budesonide; Endoscopic sinus surgery; Nasal spray inhalation

Analysis of neuro-theatre utilisation and reasons for cancellation to improve efficiency and productivity.

In neurosurgery, much emphasis has recently been placed on theatre cancellation and time utilization as a key hospital management performance indicator. We sought to evaluate our unit's theatre throughput efficiency and identify the causes of elective surgery cancellations. We retrospectively audited all scheduled elective neurosurgical procedures over a period of nine months. Mean theatre utilization time was 47.0%. The common causes of cancellations were lack of theatre time (32%), non-availability of beds in recovery room (18.6%), and insufficient preoperative patient preparation (5.5%). Inefficiencies were noted in turnover of patients and inaccurate prediction of operative time. Our theatre utilization time is consistent with available literature; however, cancellations of elective surgery waste valuable operative time and resources. The study concludes that a multi-dimensional approach must be taken to improve theatre utilization and reduce cancellation rates. A pre-assessment clinic has been introduced in order to reduce cancellation rates.

Rapid preoperative preparation of patients with thyrotoxicosis

Rapid preoperative preparation of patients with thyrotoxicosis