Surgery Recipients Research Articles

Refractive Surgery Patient Characteristics Associated With Satisfaction Scores.

To determine factors influencing patient satisfaction scores in recipients of refractive surgery. In this prospective survey-based study, patients who had refractive surgery at an outpatient refractive clinic completed a survey of selected questions from the Press Ganey survey and the National Eye Institute Visual Function Questionnaire-25. Correlation between patient-specific variables and survey questions were assessed using Student's t-tests. Fifty-three patients were recruited over a 3-year period. Most were male (55%) and middle aged (mean age: 34 years). Eleven percent underwent photorefractive keratectomy surgery and the rest had laser in situ keratomileusis, with no complications. Twenty-four percent of surveyed patients reported mild to moderate eye pain postoperatively, with the rest reporting no pain. All patients reported a full score for overall satisfaction. This study found persistent high patient satisfaction score across a variation of characteristics, suggesting that optimal scores are mainstay after refractive surgery procedures with excellent visual outcomes, independent of patient clinical and sociodemographic characteristics. [J Refract Surg. 2024;40(8):e539-e543.].

Postoperative complications and mortality after thoracic surgery of COVID-19 omicron hospital infections: A retrospective multicenter study

BackgroundPostoperative complications and mortality of Omicron hospital infection, who have undergone thoracic surgery, are scarce. MethodsBased on real-time reverse transcription polymerase chain reaction results in-hospital using nasal or pharyngeal swab samples, the patients who had undergone thoracic surgery were categorized into two groups: G1 (Omicron hospital infection) group and G2 (non- Omicron hospital infection) group. The occurrence of postoperative complications was assessed using the Clavien–Dindo classification. Both groups were compared using propensity score matching (PSM) to evaluate the occurrence of complications and mortality. The trail was enrolled in the clinical trail (NCT06040606). Results119 patients (G1, 53 and G2, 66) were included. The occurrence of postoperative complications was significantly higher in G1 group than G2 group (37.7% vs. 10.6%, respectively) (P < 0.001) and the mortality also increased (7.5% vs. 0). The logistic regression analysis identified Omicron hospital infection as the risk factors for postoperative complications (95% CI, 3.989 to 33.858). The PSM analysis indicated significant increase in postoperative complications and mortality in the G1 vs. G2 group (P < 0.01, NA). But, there was no significant difference in the occurrences of grade ≥3 complications and mortality between lung surgery and upper gastrointestinal operation, as the PSM analysis. ConclusionThe occurrences of complications and mortality significantly increased in thoracic surgery recipients with Omicron hospital infection.

Postoperative Regret Among Transgender and Gender-Diverse Recipients of Gender-Affirming Surgery

This Viewpoint examines prevalence of and factors associated with surgical regret among transgender and gender-diverse individuals who undergo gender-affirming surgery.

Acute kidney injury interacts with VKORC1 genotype on initiative warfarin dose among heart surgery recipients: a real-world research

Patients who receive heart valve surgery need anticoagulation prophylaxis to reduce the risk of thrombosis. Warfarin often is a choice but its dosage varies due to gene and clinical factors. We aim to study, among them, if there is an interaction between acute kidney injury and two gene polymorphisms from this study. We extracted data of heart valve surgery recipients from the electronic health record (EHR) system of a medical center. The primary outcome is about the average daily dose of warfarin, measured as an additive interaction effect (INTadd) between acute kidney injury (AKI) and warfarin-related gene polymorphisms. The confounders, including age, sex, body surface area (BSA), comorbidities (i.e., atrial fibrillation [AF], hypertension [HTN], congestive heart failure [CHF]), serum albumin level, warfarin-relevant gene polymorphism (i.e., CYP2C9, VKORC1), prosthetic valve type (i.e., metal, bio), and warfarin history were controlled via a multivariate-linear regression model. The study included 200 patients, among whom 108 (54.00%) are female. Further, the mean age is 54.45 years, 31 (15.50%) have CHF, and 40 (20.00%) patients were prescribed concomitant amiodarone, which potentially overlays with the warfarin prophylaxis period. During the follow-up, AKI occurred in 30 (15.00%) patients. VKORC1 mutation (1639G>A) occurred in 25 (12.50%) patients and CYPC29 *2 or *3 mutations presented in 20 patients (10.00%). We found a significant additive interaction effect between AKI and VKORC1 (− 1.17, 95% CI − 1.82 to − 0.53, p = 0.0004). This result suggests it is probable that there is an interaction between acute kidney injury and the VKORC1 polymorphism for the warfarin dose during the initial period of anticoagulation prophylaxis.

Bariatric Surgery: Preparations and Quality of Life Consequences

Introduction: Obesity is a major threat to global health. When more conventional methods have failed, obesity can be addressed via bariatric surgery. Here we examine the reasons why patients choose bariatric surgery and the behavioral consequences thereafter. Methods: A qualitative study with a phenomenological design was used to analyze detailed interview responses from recipients of bariatric surgery. Results: Before surgery, (a) bariatric surgery was chosen for obvious reasons: patients had been overweight, had obesity-related health problems and had difficulties moving; (b) Information was obtained from medical practitioners and online discussion groups; (c) Fear, anxiety and apprehension were common. Friends and family were supportive and disapproving. After surgery: (1) many chronic health problems disappeared or eased significantly; (2) Subjects experienced difficulties adjusting with changed food tastes and small portions; (3) Physical activity increased; (4) Self-esteem increased but the worry of regaining the weight remained; (5) As before surgery, there were supportive and condemning attitudes by relatives, friends and society; (6) A desire for further nutritional and psychological counseling after surgery was indicated; (7) Relationships and quality of sex improved in most cases but not always. Single women, particularly, became more active in potential relationships. Discussion: With a few exceptions, our results agree with the literature, supporting the idea that bariatric surgery leads to extensive physical, psychological and social changes. Hence, patients ought to be better prepared for these changes and medical practitioners ought to be aware of the magnitude of the changes this surgery will bring about in their patients’ lives.

Tricuspid surgery at time of mitral surgery improves survival free from severe tricuspid regurgitation but not quality of life

ObjectiveThe choice to operate on moderate tricuspid regurgitation (TR) during mitral surgery is challenging owing to limited mid-term data. We assess whether concomitant tricuspid operations improve mid-term quality of life, morbidity, or mortality. MethodsAn institutional database identified mitral surgery recipients with moderate TR at the time of surgery from 2010 to 2019. Patients were stratified by the presence of a concomitant tricuspid operation. Quality of life at the last follow-up was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Morbidity was compared using the χ2 test, Mann-Whitney U test, and Student t test. Survival was analyzed with Kaplan-Meier estimation. ResultsOf 210 mitral surgery recipients, 67 (31.9%) underwent concomitant tricuspid surgery. The concomitant tricuspid surgery cohort had greater preoperative dialysis use (10.5% vs 3.5%; P = .043) but similar age, New York Heart Association class, and cardiac surgery history relative to the nonconcomitant cohort (P > .05 for all). The concomitant tricuspid surgery cohort had a longer cardiopulmonary bypass time (144 minutes vs 122 minutes; P = .005) but a similar rate of mitral repair (P = .220). Postoperative KCCQ-12 scores reflected high quality of life in both cohorts (95.1 vs 89.1; P = .167). The concomitant tricuspid surgery cohort trended toward a higher perioperative pacemaker placement rate (22.8% vs 12.7%; P = .088) but were less likely to develop severe TR (0.0% vs 13.0%; P = .004). Overall survival was comparable between the 2 cohorts at 1 year (84.9% vs 81.6%; P = .628) and 5 years (73.5% vs 57.9%; P = .078). Five-year survival free from severe TR was higher in the concomitant cohort (73.5% vs 54.3%; P = .032). ConclusionsConcomitant tricuspid surgery for moderate TR is associated with increased 5-year survival free from severe TR but not with increased quality of life.

Aortic valve replacement for moderate aortic stenosis during mitral surgery improves survival free from severe stenosis.

Optimal management of moderate aortic stenosis during surgery for another indication is unclear. We assessed the effects of surgical aortic valve replacement for moderate aortic stenosis during mitral surgery. An institutional mitral surgery database was queried for patients with preoperative moderate aortic stenosis. Patients were stratified by whether they underwent concomitant surgical aortic valve replacement. Morbidity was analyzed using Student's t tests, Wilcoxon rank sum, chi-squared, and Fisher's exact tests. Survival was analyzed using Kaplan-Meier estimation and Cox regression. Of 85 mitral surgery recipients with moderate aortic stenosis from 2012 to 2019, 62 (73%) underwent concomitant surgical aortic valve replacement. Surgical aortic valve replacement recipients were more likely to have bicuspid (11% vs. 0%, p = 0.019) or rheumatic (18% vs. 0%, p = 0.019) aortic valves, and to undergo mitral repair (32% vs. 9%, p = 0.028). Groups did not differ with respect to mitral etiology, New York Heart Association class, or cardiac intervention history (p > 0.05). Postoperatively, groups had similar stroke and gastrointestinal bleed rates (3% vs. 0% and 2% vs. 0% in the surgical aortic valve replacement vs. no surgical aortic valve replacement group respectively, both p > 0.99). Five-year survival free from severe aortic stenosis was higher in the surgical aortic valve replacement group (66% vs. 17%, p = 0.002). Surgical aortic valve replacement protected against the composite of death and progression to severe aortic stenosis at 5 years (hazard ratio: 0.32, p = 0.003). Surgical aortic valve replacement for moderate aortic stenosis at time of mitral surgery is a well-tolerated strategy to reduce aortic disease progression.

Demographic features of patients seeking cosmetic surgery in southern Nigeria

Background and objectives: The numbers of patients undergoing cosmetic surgery is increasing worldwide, Nigeria inclusive. Whereas several reports abound describing the demographic characteristics of cosmetic surgery recipients in other regions of the world, there are no such reports in Nigeria. The objective of this study is to demonstrate the demographic characteristics of patients undergoing cosmetic surgery in Southern Nigeria. Methods: This retrospective study reviewed the case records of all patients who had cosmetic procedures at a privately owned aesthetic surgery facility in Port Harcourt, Southern Nigeria from January 2020 to December 2021 (two year period). Information on biodata; age, gender, marital status, and educational level were retrieved and analyzed. Results: In the period under review, a total of 175 patients had cosmetic surgeries done in the facility. 168 (96%) of patients were females, constituting the vast majority of patients. Only 7 (4%) patients were males. The age range of patients was from 21 years to 57 years, with a mean age of 35 years. 104 (59%) of patients were married, while 71 (41%) patients were single. 154 (88%) had at least tertiary level education. 4 (2.3%) patients only had secondary level of formal education. 17 patients (9.7%) were university/college undergraduates. Conclusions: The average cosmetic surgery recipient in Southern Nigeria is a young, married, college/university educated female.

The association between weight change after gastric cancer surgery and type 2 diabetes risk: A nationwide cohort study.

Although gastric cancer patients generally experience drastic weight decrease post-gastrectomy, the impact of weight decrease on type 2 diabetes risk remains unclear. We investigated the type 2 diabetes risk after gastric cancer surgery according to postoperative weight decrease in gastric cancer survivors in South Korea, the country with the world's highest rate of gastric cancer survival. This retrospective nationwide cohort study included gastric cancer surgery recipients between 2004 and 2014 who survived for ≥5years post-surgery. We included patients without a history of diabetes at the time of surgery and those who had not received adjuvant chemotherapy before or after the surgery. Postoperative weight loss was defined as the per cent body weight loss at 3years post-surgery compared with the baseline. The type 2 diabetes risk was evaluated using Cox regression analyses for five groups of postoperative weight decrease. In 5618 included gastric cancer surgery recipients (mean age, 55.7 [standard deviation, SD, 10.9] years; 21.9% female; mean body mass index, 23.7 [SD, 2.9] kg/m2 ), 331 patients (5.9%) developed postoperative type 2 diabetes during follow-up duration of 8.1years (median; interquartile range, 4.8years; maximum, 15.2years). Compared with those who gained weight post-surgery, patients with ≥-15% to <-10% of postoperative weight decrease (hazard ratio, 0.65; 95% confidence interval, 0.49-0.87; P=0.004) had the lowest type 2 diabetes risk. A non-linear association occurred between postoperative weight decrease and the type 2 diabetes risk in gastrectomy recipients (Akaike's information criterion [AIC] for non-linear model, 5423.52; AIC for linear model, 5425.61). A U-shaped non-linear association occurred between the type 2 diabetes risk and postoperative weight decrease in gastric cancer survivors who underwent gastrectomy. The lowest type 2 diabetes risk occurred in patients with ≥-15% to <-10% of postoperative weight decrease at 3years.

Single- versus multi-port video-assisted thoracic surgery for pulmonary aspergilloma: a propensity-matched study.

The utilization of single-port video-assisted thoracic surgery for pulmonary aspergilloma (PA) has not been well studied. The study was performed to evaluate the safety and feasibility of it for PA compared with multi-port video thoracic-assisted surgery. From August 2007 to December 2019, consecutive PA patients receiving surgeries at Shanghai Pulmonary Hospital were enrolled retrospectively. Propensity score matching based on preoperative clinical variables was utilized to compare perioperative and long-term outcomes. In all 358 patients, a total of 63 patients underwent single-port video-assisted thoracic surgery, and 63 out of 145 patients for multi-port surgeries were paired with the single-port video-assisted thoracic surgery recipients. The median follow-up period was 40 months (range, 2-140 months). Patients receiving single-port video-assisted thoracic surgery showed a similar operation time, intraoperative blood loss, drainage duration and drainage volume to those of multi-port video-assisted thoracic surgery recipients (P > 0.05). Patients undergoing lobectomy by single-port approach experienced a shorter postoperative hospital stay {4.9 [standard deviation (SD): 2.0] vs 5.9 (SD: 2.3), P = 0.014}. The average postoperative pain scores [day 0: 2.6 (SD: 0.7) vs 3.1 (SD: 0.8), day 3: 4.0 (SD: 0.9) vs 4.8 (SD: 3.9), day 7: 2.2 (SD: 0.5) vs 3.1 (SD: 0.8), P < 0.001] and the number of days that patients required analgesic agents [3.0 (SD: 2.2) vs 4.8 (SD: 2.1), P < 0.001] were also decreased in the single-port video-assisted thoracic surgery group. Single-port video-assisted thoracic surgery is a safe and feasible alternative to multi-port video-assisted thoracic surgery for simple PA and selected complex ones, with a potential advantage of reduced postoperative pain.

Trends in the surgical management of parapharyngeal space tumors: A single-center retrospective analysis.

Surgery remains the mainstay treatment for parapharyngeal space (PPS) tumors. Given the rapid advance and increasing usage of endoscopic and robotic techniques, we aimed to investigate the surgical trends of PPS tumors in our institution and analyze their impact on patients' treatment outcomes. All patients who underwent surgical resection of PPS tumors from 2014 to 2021at the Eye, Ear, Nose, and Throat Hospital of Fudan University were retrospectively reviewed. Student's t-test, Chi-square test, and multinomial logistic regression analyses were used to compare the surgical outcomes between groups. Of the included 389 patients, the recipients of endoscopic surgery have largely increased in our center, with 17 of 134 cases (12.7%) in the group 2014-2017 and 187 of 255 cases (73.3%) in the group 2018-2021. The use of transoral and trans-nasal approaches increased in recent years (5.2% in 2014-2017 vs. 26.0% in 2018-2021), while that of trans-mandibular and lateral skull base approaches decreased (5.9% in 2014-2017 vs. 0.8% in 2018-2021). Decreased blood loss of operation and decreased risks of postoperative neurovascular complications were observed in the group 2018-2021. Similar findings were observed among patients receiving endoscopic surgery when compared with those receiving conventional surgery. In our institution, the overall trends in the surgical management of PPS tumors moved towards minimally invasive approaches with the assistance of endoscopy or surgical robots. The two surgical techniques were feasible and safe, and to a great extent, contributed to the improved surgical outcomes we observed in recent years.

How intrasexual competitiveness shapes attitudes towards cosmetic surgery recipients.

Cosmetic surgery is extremely popular. Despite this, negative attitudes towards cosmetic surgery recipients prevail. Across two pre-registered studies, we examined whether intrasexual competitiveness explains these negative attitudes. Participants in Study 1 were 343 (mean age = 24.74) single heterosexual American women and participants in Study 2 were 445 (mean age = 19.03) single heterosexual Australian women. Participants in both studies were primed for either low or high intrasexual competitiveness. Contrary to our predictions, we found that priming condition did not influence participants' derogation and social exclusion of cosmetic surgery recipients. We did, however, find evidence for a 'relative attractiveness' halo effect: participants engaged in less derogation and social exclusion when they assumed cosmetic surgery recipients were more attractive than themselves. This suggests that 'pretty privilege' extends not only to women who meet conventional beauty standards, but also to those who are perceived as relatively closer to meeting these standards than the individual with whom they are engaging. Overall, we concluded that intrasexual competitiveness does not encourage the stigmatisation of cosmetic surgery recipients and examined alternative explanations for this phenomenon.

High-Impact Chronic Pain Transition in Lumbar Surgery Recipients.

High-impact chronic pain (HICP) is a term that characterizes the presence of a severe and troubling pain-related condition. To date, the prevalence of HICP in lumbar spine surgery recipients and their HICP transitions from before to after surgery are unexplored. The purpose was to define HICP prevalence, transition types, and outcomes in lumbar spine surgery recipients and to identify predictors of HICP outcomes. In total, 43,536 lumbar surgery recipients were evaluated for HICP transition. Lumbar spine surgery recipients were categorized as having HICP preoperatively and at 3 months after surgery if they exhibited chronic and severe pain and at least one major activity limitation. Four HICP transition groups (Stable Low Pain, Transition from HICP, Transition to HICP, and Stable High Pain) were categorized and evaluated for outcomes. Multivariate multinomial modeling was used to predict HICP transition categorization. In this sample, 15.1% of individuals exhibited HICP preoperatively; this value declined to 5.1% at 3 months after surgery. Those with HICP at baseline and 3 months had more comorbidities and worse overall outcomes. Biological, psychological, and social factors predicted HICP transition or Stable High Pain; some of the strongest involved social factors of 2 or more to transition to HICP (OR = 1.43; 95% CI = 1.21-1.68), and baseline report of pain/disability (OR = 3.84; 95% CI = 3.20-4.61) and psychological comorbidity (OR = 1.78; 95% CI = 1.48-2.12) to Stable Stable High Pain. The percentage of individuals with HICP preoperatively (15.1%) was low, which further diminished over a 3-month period (5.1%). Postoperative HICP groups had higher levels of comorbidities and worse baseline outcomes scores. Transition to and maintenance of HICP status was predicted by biological, psychological, and social factors.

Predictive factors for delayed hyponatremia after transsphenoidal surgery in patients with Rathke's cleft cysts.

PurposeWe aimed to assess factors influencing the occurrence of delayed hyponatremia after transsphenoidal surgery in patients with Rathke’s cleft cysts (RCCs).MethodsWe retrospectively collected the clinical data of patients who underwent transsphenoidal surgery for RCCs from January 2014 to January 2022. Univariate and multivariate analyses were used to determine the factors influencing the occurrence of postoperative delayed hyponatremia.ResultsOf the 78 microscopic transsphenoidal surgery recipients with RCCs, 15 experienced postoperative delayed hyponatremia. There were 35 men and 43 women, and mean age was 43.75 ± 14.95 years. The clinical manifestations of RCCs were headache (62 cases, 79.5%), visual dysfunction (35 cases, 44.9%), endocrine dysfunction symptoms (12 cases, 15.4%). After transsphenoidal surgery, 93.5% (58/62) had improvements in headache, and 97.1% (34/35) had improved or resolved compressive visual symptoms. Delayed hyponatremia occurred on average on day 6.46 and lasted on average for 4.40 days. Logistic regression analysis showed that the independent influencing factor of delayed hyponatremia after transsphenoidal surgery in patients with RCCs was postoperative diaphragma sellae height.ConclusionPostoperative diaphragma sellae height was identified as an independent influencing factor for delayed hyponatremia after transsphenoidal surgery in patients with RCCs.

The Influence of Pain and Resiliency on Foot and Ankle Surgery Outcomes.

Background:Resilience is the ability to recover after stressful events and has been shown to correlate with surgical outcomes. However, there has been minimal research on the impact of patient resiliency on foot and ankle surgical outcomes. This study aims to determine the predictive value of preoperative resiliency scores on surgical outcomes and investigate how this compares with the predictive value of pain scores.Methods:We conducted a retrospective review of adult patients who completed a preoperative Brief Resilience Scale (BRS) and underwent surgery between November 2019 and November 2020 with a fellowship-trained foot and ankle surgeon (N=184). Data included demographics, comorbidities, surgical details, complication and reoperation rates, pre- and postoperative opioid and benzodiazepine use, and additional patient-reported outcome measures (ie, visual analog scale [VAS], Pain Catastrophizing Scale [PCS], Pain Disability Index [PDI], Foot and Ankle Outcome Score [FAOS] pain subscale). Mean follow-up duration was 4.49 (range, 1.10-14.17) months.Results:BRS weakly correlated with decreased postoperative benzodiazepine use (P=.007). PCS magnification (P=.050) and helplessness (P=.047) subscales weakly correlated with increased follow-up duration. PDI total score and most subscores significantly correlated with an increase in at least 1 of the following: follow-up duration, or postoperative opioid or benzodiazepine use. Neither the VAS nor FAOS pain subscore correlated with any outcome. PDI total score was the strongest predictor of postoperative opioid (β=0.334) and benzodiazepine (β=0.315) use. Preoperative opioid users had significantly higher PDI total score (user=39.3, nonuser=24.9; P=.012) and subscores (ie, social activity, sexual behavior, self-care, life-support activities).Conclusion:BRS is an unreliable tool for predicting outcomes in foot and ankle surgery, as it only weakly correlated with decreased benzodiazepine use. Rather, given the PDI’s strong associations with postoperative measures in this study, physicians should consider the value of preoperative PDI completion when predicting how foot and ankle surgery recipients will fare postoperatively.Level of Evidence:Level III, retrospective cohort study.

Exploring Non-pharmacological Methods for Pre-operative Pain Management.

The management of pain is an essential aspect of surgical care, and pain levels in post-operative patients vary case by case. Treating postoperative pain is crucial as it leads to better outcomes and reduces risk of long term pain. While post-operative analgesics has been the mainstay of treatment, this mini-review explores an emerging concept which is preoperative pain management, with promising potential. Such interventions include educating patients on the expected pain outcomes and available pain medications. Non-pharmacological methods such as relaxation exercises have also proven to be effective after abdominal surgery, and educating patients on the existence of such methods pre-operatively encourages them to make use of available therapies. A major area of importance is the pre-operative psychological and emotional wellbeing of patients, as it is a strong predictor of pain and pain prognosis. Cognitive Behavioral Therapy can be effectively used to tackle preoperative anxiety and reduce pain levels. Hypnosis is another developing modality for decreasing stress. Lastly, long term pre-operative opioid use has been linked with higher pain scores and longer pain duration. This provides the basis on which pre-operative opioid weaning can lead to favorable post-operative pain outcomes.While many of these methods have not been experimented on recipients of abdominal surgery in specific, it still paves the path for newer pain control strategies that can eventually be adopted for visceral surgery patients. This review points the reader and researchers to new and developing areas that hold the potential to revolutionize current established pain management guidelines.

Effects of a spray-based oropharyngeal moisturising programme for patients following endotracheal extubation after cardiac surgery: A randomised, controlled three-arm trial

BackgroundWhen a patient emerges from cardiac surgery, they may experience intense thirst and discomfort or even impaired swallowing after endotracheal extubation. This may lead to feelings of suffocation, desperation, fear, and anxiety. Although thirst relief and dysphagia prevention share similar mechanisms, there is limited evidence for a combined intervention to alleviate thirst and prevent dysphagia. Furthermore, no studies to date have targeted postoperative cardiac patients. ObjectiveTo evaluate the safety, feasibility, and effects of a spray-based oropharyngeal moisturising programme for cardiac surgery patients following endotracheal extubation. DesignA randomised, controlled three-arm trial was conducted from October 2017 to December 2019. SettingTertiary medical centre cardiac care unit. ParticipantsParticipants (N = 145) were patients who underwent cardiac surgery and received mechanical ventilation. MethodsParticipants were randomly assigned to one of three groups: a four-part programme offering spray-based therapy with either a constant low-temperature cold spray (programme A; n = 47) or low-to-normal temperature spray (programme B; n = 49), or those that received usual care (control group; n = 49). Control group patients who complained of thirst were given wet cotton swabs to moisten their mouths. The primary outcomes included discomfort and various levels of thirst intensity; secondary outcomes included dysphagia and adverse events. Outcomes were evaluated at Time 0 (baseline), Time 1 (3 h), Time 2 (6 h) and Time 3 (96 h) post intervention. Repeated-measures analyses was performed using generalised estimating equations. ResultsThe baseline evaluation indicated no significant differences between the groups. Participants (average age: 55 years; 53.8% men) underwent cardiac surgery for; valvular heart disease (64.8%), coronary atherosclerotic heart disease (25.5%), or aortic dissection (9.7%). Baseline scores indicated moderately severe thirst (6.24±1.57) and discomfort (9.88±2.23). Post intervention, the thirst intensity in the intervention groups was significantly lower than that of the control group (p<0.001). The generalised estimating equation analysis showed no significant difference in reduced thirst intensity between programmes A and B (adjusted β=0.08, 95% CI: −0.59–0.76, p = 0.810) when controlling for intervention condition and time. Comparable results were found for reduced thirst discomfort (adjusted β=0.36, 95% CI: −0.66–1.38, p = 0.493). The three groups showed no significant differences for dysphagia frequency. No observable adverse events were reported during the intervention period. ConclusionsA spray-based oropharyngeal moisturising programme is a practical and effective intervention to alleviate patient thirst after cardiac surgery and tracheal intubation that could be integrated into comfort care for post-surgical patients’ critical care management.Tweetable abstract: A spray-based oropharyngeal moisturising programme for cardiac surgery recipients following endotracheal extubation may alleviate thirst.

Clinical Value of Surveillance 18F-fluorodeoxyglucose PET/CT for Detecting Unsuspected Recurrence or Second Primary Cancer in Non-Small Cell Lung Cancer after Curative Therapy.

Simple SummaryNon-small cell lung cancer (NSCLC) patients are at considerable risk of recurrence or second primary cancer (SPC) after curative therapy. The utility of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) surveillance to detect recurrent lesions in NSCLC patients without suspicion of recurrence has not been established. The aim of our retrospective study was to evaluate the diagnostic value of surveillance FDG PET/CT for detecting clinically unsuspected recurrence or SPC in patients with NSCLC after curative therapy. In a cohort of 2684 NSCLC patients after curative therapy, surveillance FDG PET/CT showed good diagnostic efficacy for detecting clinically unexpected recurrence or SPC. Furthermore, the diagnostic performance was improved in subgroups of patients with advanced stage prior to curative therapy, PET/CT scans performed within 3 years after curative-intent therapy, and curative surgery. Surveillance PET/CT can be more useful when performed soon after therapy in curative surgery recipients and those with an advanced disease stage considering its diagnostic efficacy and yield.We evaluated the diagnostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT surveillance for detecting clinically unsuspected recurrence or second primary cancer (SPC) in patients with non-small cell lung cancer (NSCLC) after curative therapy. A total of 4478 surveillance FDG PET/CT scans from 2864 NSCLC patients without suspicion of recurrence after curative therapy were reviewed retrospectively. In 274 of 2864 (9.6%) patients, recurrent NSCLC or SPC was found by surveillance PET/CT during clinical follow-up. Surveillance PET/CT scans showed sensitivity of 98.9% (274/277), specificity of 98.1% (4122/4201), accuracy of 98.2% (4396/4478), positive predictive value (PPV) of 77.6% (274/353), and negative predictive value of 99.9% (4122/4125). The specificity and accuracy in the curative surgery group were significantly higher than those in the curative radiotherapy group. PPV was significantly improved in subgroups of patients with advanced stage prior to curative therapy, PET/CT scans performed within 3 years after curative-intent therapy, and curative surgery. FDG PET/CT surveillance showed good diagnostic efficacy for detecting clinically unexpected recurrence or SPC in NSCLC patients after curative therapy. It can be more useful when performed soon after therapy in curative surgery recipients and those with an advanced disease stage considering its diagnostic efficacy and yield.

Knowledge, Attitudes and Practices towards SARS-CoV-2 vaccination among morbid obese individuals: a pilot study.

Background and aim.Vaccinations have dramatically impacted on the ongoing pandemic of COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As morbid obese (MO) individuals are at high risk for severe complications, their acceptance of SARS-CoV-2 vaccines is of certain public health interest.Methods.We investigated the knowledge, attitudes and eventual acceptance of SARS-CoV-2/COVID-19 vaccination among MO individuals either in waiting list, or recipients of bariatric surgery from a reference center (Parma University Hospital) shortly before the inception of the Italian mass vaccination campaign (March 2021). Data were collected through a web-based questionnaire. Association of individual factors with acceptance of SARS-CoV-2 vaccine was assessed by means of a logistic regression analysis with eventual calculation of adjusted Odds Ratios (aOR) and corresponding 95% Confidence Intervals (95%CI).Results.Adequate, general knowledge of SARS-CoV-2/COVID-19 was found in the majority of MO patients. High perception of SARS-CoV-2 risk was found in around 80% of participants (79.2% regarding its occurrence, 73.6% regarding its potential severity). Acceptance of SARS-CoV-2/COVID-19 vaccination was reported by 65.3% of participants, and was more likely endorsed by MO patients who were likely to accept some sort of payment/copayment (aOR 5.783; 1.426; 23.456), or who were more likely towards a vaccination mandate (aOR 7.920; 1.995; 31.444).Conclusions.Around one third of the MO individuals among potential recipient of bariatric surgery exhibited some significant hesitancy towards SARS-CoV-2 vaccine, and a rational approach may fail to capture and address specific barriers/motivators in this subset of individuals, stressing the importance for alternative interventions. (www.actabiomedica.it)

Evaluation of lung tumor motion in a large sample: Target-related and clinical factors influencing tumor motion based on four-dimensional CT.

Background and purposeWe aimed to analyze the influence of target‐related and clinical factors on lung tumor motion based on four‐dimensional CT (4DCT), and clarify the motion based on subgroups in lung stereotactic body radiation therapy.Materials and methods4DCT image data of 267 tumors from 246 patients were analyzed. The coordinates in the left–right (LR), anterior–posterior (AP), and cranial–caudal (CC) directions of the center of mass (COM) of the gross tumor volumes in 10 phases of 4DCT were measured. The peak‐to‐peak COM displacement in the LR, AP, CC, and 3D directions was calculated. The influence of target‐related and clinical factors on tumor motion was evaluated using multivariate analysis.ResultsThe tumor segment location correlated with the tumor motion in each direction. Tumor size was predictive of tumor motion in the 3D (p = 0.023) and AP directions (p = 0.049). The tumor motion for metastatic tumors was smaller than that for primary tumors in the LR (p = 0.019) and AP directions (p = 0.008). The CC motion for pulmonary surgery recipients (3.8 ± 4.5 mm) was less than that for patients who had not undergone surgery (5.6 ± 5.4 mm), and no significant clinical factor was observed. BSA and BMI were positively correlated with the motion in the CC (p = 0.02) and LR directions (p = 0.002).ConclusionThe tumor segment location was a good predictor of tumor motion. A larger tumor tends to have a smaller motion. Patients with metastatic tumors or those who have undergone pulmonary surgery exhibited smaller and more unpredictable tumor motions, which required individual assessments. Thus, clinical factors can potentially predict tumor motion.