Recovery Of Surgical Patients Research Articles

Mini-laparotomy in emergency general surgery in a second-level hospital: a prospective study

Background: Mini-laparotomy (ML) is one of the approaches aimed to reduce intraoperative stress and enhance recovery in surgical patients. The objective was to determine how safe and feasible ML access is in emergency surgery. Methods: This prospective, two-group, parallel active-controlled study evaluated adult patients operated on for acute abdominal conditions at a second-level hospital. Patients explored with the use of ML and those having standard laparotomy access (SL) formed two arms of the study. Cases of abdominal malignancy, generalised peritonitis, and patients scheduled for relaparotomy procedure were excluded. Length of hospital stay and 30-day morbidity/mortality were primary endpoints. Secondary outcomes were operative time, estimated blood loss during the procedure, and postoperative pain control. Results: Thirty-five patients were explored through ML, and 33 had an SL incision. The size of ML ranged from 6 to 12 cm, with the median being 10.5 cm. Employment of ML was associated with reduced length of stay (p=0.008), shorter operative time (p=0.003), and minimised need for opioid analgesia (p=0.008); however, the difference in postoperative complications was not statistically significant (ML: 20% versus SL: 27%, p=0.48) and mortality was similar in both groups (6%). Conclusion: Our data demonstrate that ML is a safe technique that could be used for the treatment of urgent abdominal conditions in selected patients. Having comparable postoperative morbidity with the SL approach, it might lead to reduced pain and enhanced recovery after the procedure. Keywords: Mini-laparotomy, standard laparotomy, emergency general surgery

Examination of Perception of Nursing Care and Quality of Recovery in Surgical Patients According to Some Variables

Objective: The study aims to determine the relationship between the quality of care perception and healing quality levels of surgical patients and to determine the differences according to their characteristics. Materials and Methods: The descriptive cross-sectional study was carried out on 237 patients treated in the surgical clinics of a university hospital from December 2021 to May 2022. Data were collected using a descriptive information form, the Patient's Perception of Nursing Care Scale, and the Quality of Recovery-40 Scale. Results: The mean total score of the Patient's Perception of Nursing Care Scale was 71.45±9.81, and the mean total score of the Quality of Recovery-40 Scale was 106±15.95. The mean score of the physical independence sub-dimension of the Quality of Recovery-40 Scale was the highest (21.14±5.73), and the mean score of the pain sub-dimension was the lowest (9.32±3.57). There was statistically significant relationship between gender, having a companion, and Patient's Perception of Nursing Care Scale and between having a chronic disease and the Quality of Recovery-40 Scale. Conclusion: It was found that the level of patient's perception of nursing care was high, the level of recovery quality was below average, and there was no relationship between the level of perception of nursing care.

Factor structure of post-operative quality of recovery questionnaire (QoR-15): An Italian adaptation and validation.

The Quality of Recovery questionnaire (QoR-15) is an English instrument for measuring quality of recovery in surgical patients, not yet translated and validated in Italian when the Enhanced Recovery After Surgery (ERAS) Piemonte studies were planned. To produce the Italian version of the QoR-15 questionnaire, to evaluate its factorial structure and to assess the invariance between two types of surgery. The Italian version (QoR-15I) was obtained translating and adapting the original version to the Italian context. The validation was performed suppling the QoR-15I to 3,784 patients enrolled in two parallel stepped wedge cluster randomised trials (ERAS Colon-rectum Piemonte; ERAS Gyneco Piemonte). The factor structure and its invariance between types of surgery was tested using confirmatory bifactor model and multi-group analysis. Comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR) fit indices and their changes between nested models were used to assess the factor structure and the invariance. The bifactor model showed good fit (RMSEA = 0.049, CFI =0.957, SRMR = 0.036) and provided a general recovery factor and two specific factors for physical and mental recovery. Eighty-four percent of the common variance is attributable to the general factor, and thus the QoR-15I is sufficiently 'one-dimensional' with an adequate reliability (ωh = 0.70). The ωs values for the physical and mental recovery factors were 0.01 and 0.13, respectively. Multigroup analysis supported configural (RMSEA = 0.053, CFI = 0.950, SRMR = 0.035) and metric invariance (ΔRMSEA = -0.004; ΔCFI = -0.002; ΔSRMR = 0.014), whereas the intercept constraint was removed from item 15 to obtain partial scalar invariance (ΔRMSEA = 0.002; ΔCFI = 0.007; ΔSRMR = 0.004). Construct validity was supported by a negative association of QoR-15I scores with all variables related to worse patient condition and more complex surgery. Our results support the use of the QoR-15I as a valid, reliable, and clinically feasible tool for measuring the quality of recovery after surgery. The results of the confirmatory factor analyses suggest that a unique recovery score can be calculated and support measurement invariance of the QOR-15I across the two type of surgery, suggesting that the questionnaire has the same meaning and the same measurement parameters in colorectal and gynaecologic patients.

Pharmacotherapy for improving postoperative sleep quality: a protocol for a systematic review and network meta-analysis

IntroductionImproving the quality of sleep may promote enhanced recovery in surgical patients. In addition to controversial or conflicting study conclusions, the current clinical studies on pharmacotherapy for improving postoperative sleep...

Effect of Pain-Coping Strategies on Post-Operative Pain Perception and Recovery in Surgical Patients

Effect of Pain-Coping Strategies on Post-Operative Pain Perception and Recovery in Surgical Patients

Comparison of the effects of neostigmine and sugammadex on postoperative residual curarization and postoperative pulmonary complications by means of diaphragm and lung ultrasonography: a study protocol for prospective double-blind randomized controlled trial

BackgroundPostoperative residual curarization (PORC) may be a potential risk factor of postoperative pulmonary complications (PPCs), and both of them will lead to adverse consequences on surgical patient recovery. The train-of-four ratio (TOFr) which is detected by acceleromyography of the adductor pollicis is thought as the gold standard for the measurement of PORC. However, diaphragm function recovery may differ from that of the peripheral muscles. Recent studies suggested that diaphragm ultrasonography may be useful to reveal the diaphragm function recovery, and similarly, lung ultrasound was reported for the assessment of PPCs in recent years as well. Sugammadex reversal of neuromuscular blockade is rapid and complete, and there appear to be fewer postoperative complications than with neostigmine. This study aims to compare the effects of neostigmine and sugammadex, on PORC and PPCs employing diaphragm and lung ultrasonography, respectively.Methods/designIn this prospective, double-blind, randomized controlled trial, patients of the American Society of Anesthesiologists Physical Status I–III, aged over 60, will be enrolled. They will be scheduled to undergo arthroplasty under general anesthesia. All patients will be allocated randomly into two groups, group NEO (neostigmine) and group SUG (sugammadex), using these two drugs for reversing rocuronium. The primary outcome of the study is the incidence of PPCs in the NEO and SUG groups. The secondary outcomes are the evaluation of diaphragm ultrasonography and lung ultrasound, performed by an independent sonographer before anesthesia, and at 10 min and 30 min after extubation in the post-anesthesia care unit, respectively.DiscussionElimination of PORC is a priority at the emergence of anesthesia, and it may be associated with reducing postoperative complications like PPCs. Sugammadex was reported to be superior to reverse neuromuscular blockade than neostigmine. Theoretically, complete recovery of neuromuscular function should be indicated by TOFr > 0.9. However, the diaphragm function recovery may not be the same matter, which probably harms pulmonary function. The hypothesis will be proposed that sugammadex is more beneficial than neostigmine to reduce the incidence of PPCs and strongly favorable for the recovery of diaphragm function in our study setting.Trial registrationClinicalTrials.gov NCT05040490. Registered on 3 September 2021

Impact of preoperative surgical anxiety on postoperative surgical recovery among surgical patients: role of surgical coping

Objective: The present study examined the moderating impact of surgical coping in the relationship between pre-operative surgical anxiety and post-operative surgical recovery in surgical patients. Methods: The study was carried out in surgical departments of various hospitals situated in different areas of Province of the Punjab including Allied Hospital Faisalabad, DHQ Teaching Hospital Sargodha, Jinnah Hospital Lahore and Margalla Institute of Health Sciences Rawalpindi over the period of one-year May 1, 2018 to May 1, 2019. It was a descriptive research based on survey research design A purposive sample of pre-operative and post-operative surgical patients (N = 200) from Amsterdam Pre-operative Anxiety and Information Scale1, Surgical Recovery Scale2, and Coping with Surgical Stress Scale3 were used to collect information on study variables. Moderation analysis applied through PROCESS Marco 3.2. Results: Findings revealed that only two coping strategies including threat avoidance (p<.001) and information seeking (p<.001) moderated the relationship between surgical anxiety and surgical recovery of surgical patients. Conclusion: The study shed light on the importance of educating surgical patients regarding the use of appropriate coping strategies for their prompt recovery from surgery. The study has applied significance in the field of health psychology in general and for surgical patients in particular. Keywords: Surgical anxiety, surgical recovery, coping, threat avoidance, information seeking. Continuous...

Leadership skills in surgeons: a review of the literature

Clinicians, professors of medicine in general, students, and professionals from the health sciences tend to focus their efforts on technical training related to their discipline in practice as well as activities that produce some benefit direct or personal satisfaction. It is unusual to devote time and effort to training in areas such as teaching or expand their skills in sociological and organizational aspects. Would you like to take a course on strategic planning if not a director or officer of the hospital? Manage time in your schedule for a workshop on communication and conflict management? Have room in your schedule for educational activities on leadership, organizational change, and diffusion of innovations, science or science complexity of implementation? Generally, doctors and teachers do not spend much time on these activities (at least voluntarily) because we feel that what we have learned from these topics on personal experience is enough. Effective teamwork, not only in the operating room but also throughout the perioperative route is considered an important and critical component of the safety and effectiveness of surgical care and leads to good results and quick recovery of surgical patients. Therefore, considerable efforts have been made to understand how teams work within the route of surgical care and to improve teamwork. The simple act of bringing together some experts does not guarantee that turned out an expert team. Given the evidence suggests that teamwork in the operating room sometimes is far from harmonious and effective, the importance of training the surgical team to work effectively is receiving international acceptance as a key strategy to maximize safety in surgery. This systematic literature review aims to present a review of literature that focuses on the importance and role of leadership skills in the surgeon and how these skills can play a significant role in increasing the quality of care and patients’ safety in operating room (OR) settings.

Enhanced Recovery after Surgery for Lung Cancer Patients.

BackgroundEnhanced recovery after surgery (ERAS) is a perioperative treatment intended to speed up recovery of surgical patients. Pulmonary lobectomy is a high-risk procedure, which ERAS is intended to address.ObjectiveWe evaluated the application of ERAS to patients with lung cancer.Interventions/MethodsOf 337 patients who underwent pulmonary lobectomies for lung cancer at our hospital, 168 received traditional perioperative nursing, and 169 received ERAS. Their complication rates, numerical rating scale of pain (NRS), satisfaction with care, demographics and some inpatient indices before and after surgery were compared.ResultsThe two groups did not significantly differ in general data or NRS score at 6 post-operative hours (P = 0.214) and 1 post-operative day (POD; P = 0.027). The ERAS group had lower incidence of postoperative lung complication (P = 0.008), shorter length of stay (P < 0.001), shorter enterokinesia recovery times (P < 0.001), lower hospitalization costs (P < 0.001), lower NRS scores at POD 2–5 (P < 0.001), higher nursing satisfaction (P < 0.001), and higher postoperative pulmonary function indices of maximal voluntary ventilation (MVV; P < 0.001), forced vital capacity (FVC; P = 0.002), and forced expiratory volume in 1 second (FEV1; P = 0.002) than did the traditional group.ConclusionERAS is applicable to lung surgery patients.Implications for PracticeApplying ERAS to thoracic surgery patients can alleviate their postoperative pain, shorten enterokinesia recovery, lower postoperative complication incidence, reduce hospitalization expenses, and raise nursing satisfaction, thereby expediting recovery.

Previous Use of Mammography as a Proxy for General Health Checks in Association with Better Outcomes after Major Surgeries.

Although previous studies have shown that health checks may improve several risk factors for chronic diseases, the effect of preoperative health checks on postoperative recovery in surgical patients remains unknown. We aimed to investigate the association between preoperative use of mammography and the risk of perioperative complications. We conducted a matched cohort study of 152,411 patients aged ≥47 years who received mammography screening and later underwent major surgery from 2008 to 2013. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 152,411 controls who underwent surgery but were not screened were selected. We collected patients’ characteristics and medical conditions from claims data of Taiwan’s National Health Insurance. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative complications and in-hospital mortality associated with mammography screening. Patients receiving mammography prior to major surgery had significantly lower risks of perioperative complications, including pneumonia, septicemia, acute renal failure, stroke, urinary tract infection, deep wound infection, acute myocardial infarction, intensive care unit stay, and 30 day in-hospital mortality (OR 0.45, 95% CI 0.38–0.53). The association was consistent across each stratum of age, number of hospitalizations, emergency visits, and comorbidities. In conclusion, preoperative use of mammography was strongly associated with fewer perioperative complications and less in-hospital mortality after major surgeries. The evidence provided by this study justifies the implementation of preoperative health checks in clinical practice.

Research progress in perioperative pain nursing

Perioperative pain is a common problem faced by surgical patients. Pain seriously affects patients' mood, sleep, and functional exercise, resulting in delayed recovery and longer hospital stay. Perioperative pain management has received increasing attention as medical standards develop and awareness of pain increases. This article will describe the concept of perioperative pain (definition and criteria of pain, current status and significance of pain management) , pain assessment (contents of pain assessment, common pain assessment tools, time and criteria for pain assessment) , pain-related nursing, and propose that perioperative pain care can effectively improve the patients' mental state and physiological conditions, which plays an important role in achieving rapid recovery of surgical patients. Key words: Pain; Perioperative nursing; Assessment tool; Multidimensional scale

A new clinical guideline for the application of enhanced recovery protocols (ERPs) in colorectal surgery: an update of the evidence levels for the measures to be applied?

Enhanced recovery protocols (ERPs), also known as fasttrack or enhanced recovery after surgery (ERAS) protocols, were first developed by Professor Henrik Kehlet in the 1990s with a clear objective, namely to improve the recovery of surgical patients by following a multimodal strategy aimed at reducing in-patient complications and surgical stress by way of a series of pre-, peri- and postoperative measures and care.

The Effect of Therapeutic Touch on Postoperative Patients

Therapeutic Touch (TT) is a complementary modality that has been demonstrated to reduce psychological distress and help patients to relax. It is unclear if there is an impact of TT on biobehavioral markers such as cortisol and natural killer cells (NKCs). There is some preliminary evidence that suggests relaxation may have positive effects on the immune system. To test the efficacy of TT on pain and biobehavioral markers in patients recovering from vascular surgery. The study was grounded in a psychoneuroimmunology framework to address how complementary therapies affect pain and biobehavioral markers associated with recovery in surgical patients. This was a between-subjects intervention study. Twenty-one postoperative surgical patients. Measures of level of pain and levels of cortisol and NKCs were obtained before and after a TT treatment. Compared with those who received usual care, participants who received TT had significantly lower level of pain, lower cortisol level, and higher NKC level. Evidence supports TT as a beneficial intervention with patients. Future research on TT is still needed to learn more about how it functions. However, there is evidence to support incorporating TT into nursing practice.

Ornamental Indoor Plants in Hospital Rooms Enhanced Health Outcomes of Patients Recovering from Surgery

Clinical trials have not been reported concerning the health benefits of viewing indoor plants on stress and recovery of surgical patients within a hospital setting. Using various medical and psychologic measurements, this study performed a randomized clinical trial with surgical patients to evaluate whether plants in hospital rooms have therapeutic influences. Ninety (90) patients recovering from a hemorrhoidectomy were randomly assigned to either control or plant rooms. With half the patients, live plants were placed in their rooms during postoperative recovery periods. Data collected for each patient included length of hospitalization, analgesics used for postoperative pain control, vital signs, ratings of pain intensity, pain distress, anxiety and fatigue, the State-Trait Anxiety Inventory Form Y-1, the Environmental Assessment Scale, and the Patient's Room Satisfaction Questionnaire. Viewing plants during the recovery period had a positive influence linking directly to health outcomes of surgical patients. Patients in hospital rooms with plants and flowers had significantly more positive physiologic responses evidenced by lower systolic blood pressure, and lower ratings of pain, anxiety, and fatigue than patients in the control room. Patients with plants also felt more positively about their rooms and evaluated them with higher satisfaction when compared with patients in similar rooms without plants. Based on patients' comments, plants brightened up the room environment, reduced stress, and also conveyed positive impressions of hospital employees caring for patients. Findings of this study confirmed the therapeutic value of plants in the hospital environment as a noninvasive, inexpensive, and effective complementary medicine for surgical patients. Health care professionals and hospital administrators need to consider the use of plants and flowers to enhance healing environments for patients.

Clinimetric properties of 3 instruments measuring postoperative recovery in a gynecologic surgical population

General, health-related quality-of-life questionnaires and recovery-specific questionnaires have been used to measure recovery in surgical patients. The aim of this study was to evaluate the clinimetric properties of 3 recovery instruments and to examine whether recovery-specific instruments are useful. The Quality of Recovery-40 (QoR-40), Recovery Index-10 (RI-10), and RAND-36 health survey were used to measure recovery in women undergoing different types of hysterectomy in the first 12 weeks after operation. Construct validity was assessed by testing predefined hypotheses. The changes observed during the postoperative period were used as indicators for responsiveness. One hundred and sixty-one women were included. Response rate and internal consistency were found satisfactory. The highest number of hypotheses used for assessment of construct validity was confirmed in the RI-10. The RI-10 was more responsive compared with the QoR-40 and the RAND-36. Because construct validity and responsiveness were greatest in the RI-10, we conclude that this short recovery-specific instrument is useful in studies evaluating postoperative recovery. We recommend the use of the RI-10, unless the immediate postoperative days are of interest in which the QoR-40 was valid.

164: Clinimetric Properties of Three Instruments Measuring Postoperative Recovery in a Gynecologic Surgical Population

General health-related quality of life questionnaires and recovery specific questionnaires have been used to measure recovery in surgical patients. The aim was to evaluate the clinimetric properties of three recovery instruments in hysterectomy patients.

Validação de um instrumento de registro para sala de recuperação pós-anestésica

OBJETIVO: validar o conteúdo de um instrumento de registro para avaliação do paciente na unidade de recuperação pós-anestésica. MÉTODOS: utilizou-se a técnica Delphi para a coleta de dados que se procedeu em duas fases. RESULTADOS: os resultados obtidos mostraram que dos 8 itens que compunham o instrumento 7 deles (87,5%) foram mantidos e todos com algum tipo de alteração, sendo que os itens de: admissão e de avaliação de sinais vitais, índice de Aldrete e Kroulik e índice pediátrico, prescrição de enfermagem e o espaço para anotação obtiveram consenso de 100% dos juízes para que fossem mantidos no instrumento. Para 11 juízes (79%) o item diversos encontrava-se bastante repetitivo devendo ser excluído. Outro item mantido, pela concordância de 64% dos juízes, foi a avaliação do paciente na admissão e alta da sala de recuperação, apesar de ser aquele com maior índice de alterações. Após as alterações sugeridas, o instrumento foi modificado, reenviado, e analisado novamente pelos juízes, porém estas não atingiram a concordância mínima estabelecida pela técnica utilizada. CONCLUSÃO: considerou-se após estas duas fases que o instrumento foi validado quanto ao seu conteúdo e forma de apresentação, sendo necessárias adequações, de acordo com o tipo de pacientes e de instituição.

Life satisfaction and active coping style are important predictors of recovery from surgery

Objective: The objectives of this study were to investigate the influence of psychological factors on the recovery of surgical patients and to explore whether there are any psychological variables other than anxiety that have a significant influence on recovery from surgery. Methods: The participants were 112 adult patients undergoing a variety of surgical procedures. On the day prior to surgery, the Freiburg Personality Questionnaire, the State–Trait Anxiety Inventory, a coping schedule and the Questionnaire of Social Support were used to measure psychological parameters including personality, anxiety, coping and social support. The quality of the surgical outcome was rated by two independent and blinded surgeons by the length of hospital stay and analgesia and sedation requirements. The ratings controlled for the diagnosis, type of operation, intraoperative complications, postoperative medical problems and health limitations independent of the surgical procedure. Results: Patients who had a complicated recovery were found to have reduced life satisfaction and lower situation-specific self-control expectations. Structural equation modeling revealed direct relationships between recovery from surgery and personality dimensions with the strongest correlations to life satisfaction, extraversion and attainment orientation. Conclusion: The data from this study suggests that valid predictions of the course of postoperative recovery need to take into account personality and coping behaviour orientated data as well as clinical variables. No direct influence on recovery could be predicted from preoperative state anxiety, but it seems likely that state anxiety may influence coping behaviour and that it is this that appears to have a significant impact to surgical recovery.

Epidural Analgesia versus Intravenous Patient-Controlled Analgesia

Background and objectives This study evaluated 462 consecutive surgical cancer patients who underwent uncomplicated surgeries of the thorax or abdomen, or both, of more than 3 hours duration between 1989 and 1991. Methods Patients received either epidural analgesia (EA group) with 0.1% bupivacaine, 0.01% morphine sulfate after combined general-epidural anesthesia, or parenteral morphine therapy via intravenous patient-controlled analgesia (IV-PCA) after balanced general anesthesia after the operation. Patients in both the EA (n = 352) and IV-PCA (n = 100) groups were compared for demographics, length of surgical intensive care unit (SICU), and hospital stays. Moreover, the same comparisons were performed when patients were allocated into surgical subgroups: thoracic (TH), upper abdominal (UA), lower abdominal (LA), radical hysterectomies (RH), and RH with colon resection (RHCR). Results No differences existed with respect to age or sex between the EA and IV-PCA groups. All patients reported adequate dynamic pain control as evaluated with visual analog pain scores (VAS Conclusions The use of both analgesic techniques was associated with satisfactory postoperative pain control. However, patients receiving epidural anesthesia and analgesia experienced faster recovery as judged by shorter mechanical ventilation time, and decreased SICU and hospital stays, resulting in significantly lower hospitalization costs. The use of perioperative epidural techniques should be considered to expedite recovery of surgical patients, and has the added benefit of being cost effective by reducing hospital stays.

Role of suggestion in surgical convalescence.

Introduction Strong evidence exists that suggestion plays an important role in the recovery of surgical patients after uncomplicated procedures. Dohan et al. 1-3 have observed that surgeons are not in agreement relative to the optimal duration of convalescence after common, uncomplicated surgery. On the basis of a survey of the duration of convalescence of a group of patients undergoing similar procedures by various surgeons, they concluded that, The surgeon's recommendation is the major determinate of the total duration of uncomplicated convalescence in most patients. Beecher 4 feels that the enthusiasm or skepticism of a surgeon may influence the therapeutic result of an operation. He states: Placebo effects are potent where there is strong motivation on the part of the patient toward recovery. Weiss and English 5 state that the surgical patient is in a very suggestible frame of mind. In a more direct experimental approach Wolff and his associates 6,7